Low-Molecular-Weight Heparin Versus Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients With Cancer

Abstract

Patients with cancer have a substantial risk of recurrent thromboembolism and hemorrhage when they received standard oral anticoagulant therapy for the treatment and prevention of acute venous thromboembolism. The authors performed a six-month, multicenter, randomized open-label clinical trial to investigate whether low-molecular-weight heparin is a safe and effective therapy in preventing recurrent thromboembolism in this group of patients. Cancer patients with deep vein thrombosis, pulmonary embolism, or both, were randomly assigned to receive (1) low-molecular-weight heparin subcutaneously and a coumarin derivative for 6 months (336 patients), or (2) the low-molecular-weight heparin alone for 6 months (336 patients). In the oral anticoagulation group, 53 of 336 patients had recurrent venous thromboembolism, compared with 27 of 336 patients in the low-molecular-weight heparin group. No significant difference was detected between the groups in the rate of bleeding. The low-molecular-weight heparin group had a lower mortality rate (39%) than the oral anticoagulation group (41%). The authors concluded that lowmolecular-weight heparin was more effective than an oral anticoagulant in reducing the risk of recurrent thromboembolism and did not increase the risk of bleeding.

Keywords

venous thromboembolism low-molecular-weight heparin warfarin resistance recurrence

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