Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study - PubMed (original) (raw)

Clinical Trial

Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study

Guy Meyer et al. Arch Intern Med. 2002 Aug.

Abstract

Background: The use of warfarin sodium for treating venous thromboembolism in patients with cancer is associated with a significant risk of recurrence and bleeding. The use of low-molecular-weight heparin sodium for secondary prevention of venous thromboembolism in cancer patients may reduce the complication rate.

Objective: To determine whether a fixed dose of subcutaneous low-molecular-weight heparin is superior to oral warfarin for the secondary prophylaxis of venous thromboembolism in patients with cancer and venous thromboembolism.

Methods: In a randomized, open-label multicenter trial performed between April 1995 and March 1999, we compared subcutaneous enoxaparin sodium (1.5 mg/kg once a day) with warfarin given for 3 months in 146 patients with venous thromboembolism and cancer.

Main outcome measure: A combined outcome event defined as major bleeding or recurrent venous thromboembolism within 3 months.

Results: Of the 71 evaluable patients assigned to receive warfarin, 15 (21.1%; 95% confidence interval [CI], 12.3%-32.4%) experienced one major outcome event compared with 7 (10.5%) of the 67 evaluable patients assigned to receive enoxaparin (95% CI, 4.3%-20.3%; P =.09). There were 6 deaths owing to hemorrhage in the warfarin group compared with none in the enoxaparin group. In the warfarin group, 17 patients (22.7%) died (95% CI, 13.8%-33.8%) compared with 8 (11.3%) in the enoxaparin group (95% CI, 5.0%-21.0%; P =.07). No difference was observed regarding the progression of the underlying cancer or cancer-related death.

Conclusions: These results confirm that warfarin is associated with a high bleeding rate in patients with venous thromboembolism and cancer. Prolonged treatment with low-molecular-weight heparin may be as effective as oral anticoagulants and may be safer in these cancer patients.

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Comment in

International normalized ratio and anticoagulation.
Theerman MR. Theerman MR. Arch Intern Med. 2003 May 26;163(10):1242-3; author reply 1244. doi: 10.1001/archinte.163.10.1242-c. Arch Intern Med. 2003. PMID: 12767971 No abstract available.
Apparent warfarin potency inconsistencies compromise effectiveness.
Rothschild BM. Rothschild BM. Arch Intern Med. 2003 May 26;163(10):1243; author reply 1244. doi: 10.1001/archinte.163.10.1243-a. Arch Intern Med. 2003. PMID: 12767972 No abstract available.
Is low-molecular-weight heparin safer than warfarin for secondary prevention of venous thromboembolism in cancer patients?
Caine GJ, Lip GY. Caine GJ, et al. Arch Intern Med. 2003 May 26;163(10):1243-4; author reply 1244. doi: 10.1001/archinte.163.10.1243-b. Arch Intern Med. 2003. PMID: 12767973 No abstract available.

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Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study - PubMed (original) (raw)