Perspectives in Vascular Surgery and Endovascular Therapy

 

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Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 16, No. 2, 144-146 (2004)
DOI: 10.1177/153100350401600217

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

Britt H. Tonnessen, MD

Ochsner Clinic Foundation, 1516 Jefferson Highway, New Orleans, LA 70123

Samuel R. Money, MD, MBA

Ochsner Clinic Foundation, 1516 Jefferson Highway, New Orleans, LA 70123; smoney{at}ochsner.org

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.

Key Words: venous thromboembolism • low-molecular-weight heparin • warfarin resistance • recurrence


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