title: The efficacy and safety of oral anticoagulation in patients with cancer.
abstract: OBJECTIVE
  To compare the complication rate (bleeding and thrombosis) of oral anticoagulation in a cohort of patients with cancer to a cohort without cancer.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Outpatient anticoagulation clinic in a community hospital.
  
  
  METHODS
  Consecutive patients enrolled in an anticoagulation clinic: 44 with cancer, 64 without cancer.
  
  
  METHODS
  Patients received prophylactic doses of Warfarin (target INR 2-3 in the majority of instances) and complication rates were assessed.
  
  
  METHODS
  Major bleeding (strictly defined), minor bleeding, recurrent thrombosis, proportion of time with therapeutic INR, frequency of clinic visits.
  
  
  RESULTS
  The rates of major bleeding, minor bleeding, and recurrent thrombosis were not statistically significantly different in the two groups of patients. Therapeutic INR's were more difficult to sustain in the cancer patients as compared to the non-cancer patients (43.3% vs 56.9%, p < 0.0001). There was a non significant trend towards more frequent monitoring for the cancer patients compared with the non-cancer patients (4.6 vs 3.5 visits per treatment month, p = 0.14).
  
  
  CONCLUSIONS
  Oral anticoagulation is safe and effective in the patient with cancer. It is more difficult to sustain a therapeutic INR in the cancer patients and they may need more frequent monitoring to achieve a low complication rate.
authors.affiliation: Department of Medicine, St. Francis Hospital and Medical Center, Hartford, CT 06105, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Bona
authors.forename: K Y
authors.initials: KY
authors.lastname: Sivjee
authors.forename: A D
authors.initials: AD
authors.lastname: Hickey
authors.forename: D M
authors.initials: DM
authors.lastname: Wallace
authors.forename: S B
authors.initials: SB
authors.lastname: Wajcs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011446:Prospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin