title: Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer.
abstract: BACKGROUND
  Patients with cancer have a substantial risk of recurrent thrombosis despite the use of oral anticoagulant therapy. We compared the efficacy of a low-molecular-weight heparin with that of an oral anticoagulant agent in preventing recurrent thrombosis in patients with cancer.
  
  
  METHODS
  Patients with cancer who had acute, symptomatic proximal deep-vein thrombosis, pulmonary embolism, or both were randomly assigned to receive low-molecular-weight heparin (dalteparin) at a dose of 200 IU per kilogram of body weight subcutaneously once daily for five to seven days and a coumarin derivative for six months (target international normalized ratio, 2.5) or dalteparin alone for six months (200 IU per kilogram once daily for one month, followed by a daily dose of approximately 150 IU per kilogram for five months).
  
  
  RESULTS
  During the six-month study period, 27 of 336 patients in the dalteparin group had recurrent venous thromboembolism, as compared with 53 of 336 patients in the oral-anticoagulant group (hazard ratio, 0.48; P=0.002). The probability of recurrent thromboembolism at six months was 17 percent in the oral-anticoagulant group and 9 percent in the dalteparin group. No significant difference between the dalteparin group and the oral-anticoagulant group was detected in the rate of major bleeding (6 percent and 4 percent, respectively) or any bleeding (14 percent and 19 percent, respectively). The mortality rate at six months was 39 percent in the dalteparin group and 41 percent in the oral-anticoagulant group.
  
  
  CONCLUSIONS
  In patients with cancer and acute venous thromboembolism, dalteparin was more effective than an oral anticoagulant in reducing the risk of recurrent thromboembolism without increasing the risk of bleeding.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ont., Canada.
authors.forename: Agnes Y Y
authors.initials: AY
authors.lastname: Lee
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
authors.forename: Ross I
authors.initials: RI
authors.lastname: Baker
authors.forename: Chris
authors.initials: C
authors.lastname: Bowden
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Kakkar
authors.forename: Martin
authors.initials: M
authors.lastname: Prins
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Rickles
authors.forename: Jim A
authors.initials: JA
authors.lastname: Julian
authors.forename: Susan
authors.initials: S
authors.lastname: Haley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kovacs
authors.forename: Michael
authors.initials: M
authors.lastname: Gent
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D017985:Dalteparin / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011655:Pulmonary Embolism / Q000401:mortality / Q000517:prevention & control*; D055502:Secondary Prevention; D016019:Survival Analysis; D013923:Thromboembolism / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000074:Acenocoumarol; D017985:Dalteparin