Hypercoagulable states and thromboembolism are well-known hallmarks of different malignancies, including lung cancer. Risk factors that lead to cancer-associated thrombosis include cancer type, radiotherapy, chemotherapy, and immunotherapy. To date, low-molecular-weight heparin (LMWH) preparations are administrated for prophylaxis and treatment of cancer-associated thrombosis. Pre-clinical findings indicate that, apart from the antithrombotic properties, LMWHs exhibit anti-angiogenetic and anti-metastatic effects. However, randomized trials have not been able to show survival advantages in lung cancer patients treated with LMWH. We aimed to assess the effects of LMWH therapy in a retrospective cohort of 2486 lung cancer patients included in the database of Heidelberg`s biobank, Germany.

Our data show that non-small cell lung cancer (NSCLC) patients in general or with stage IV cancer receiving LMWH therapy have significantly lower survival than those without LMWH therapy. We cannot answer if our finding is related to the LMWH therapy per se or is associated with comorbidities such as hypertension, cardiovascular diseases, diabetes, and chronic pulmonary disease. Nevertheless, LMWH therapy itself does not have beneficial effects on NSCLC patient survival and therefore should not be a part of the standard treatment of NSCLC but only be considered as a personalized therapy when required.