Fixed-dose low-molecular-weight heparin for secondary prevention of venous thromboembolism in patients with disseminated cancer: a prospective cohort study.
BACKGROUND
Secondary prevention of venous thromboembolism (VTE) with vitamin K antagonists is often problematic in patients with cancer. We prospectively evaluated the effectiveness and safety of long-term subcutaneous dalteparin in a series of consecutive patients with symptomatic VTE and metastatic cancer.


METHODS
The study included 203 patients, aged 36-96 years. The initial treatment consisted of a 7-day course of subcutaneous dalteparin according to body weight. Then, patients received a fixed dose of 10 000 IU dalteparin once daily for at least 3 months. In patients developing transient thrombocytopenia the dose was reduced to 5000 IU daily while the platelet count remained <50,000; and to 2500 IU daily while it remained <10 000. Patients undergoing any surgical intervention during the study were put on 5000 IU daily during the first 4 days, switching thereafter to 10,000 IU. Patients undergoing any other invasive procedure (i.e. biopsies, punctures) received a 5000 IU dose the same day, instead of 10 000 IU.


RESULTS
Eleven patients (5.4%) developed major bleeding complications (6 fatal) during the 3-month study period, and 18 patients (8.9%) developed VTE recurrences (2 patients died). There were no higher complication rates in patients with either liver or brain metastases, nor during thrombocytopenia, surgery or invasive procedures.


CONCLUSIONS
Fixed dose 10,000 IU subcutaneous dalteparin once daily for 3 months was not associated with more complications in patients with liver or brain metastases. The dose adjustment for patients with thrombocytopenia, surgery or invasive procedures was safe too.
Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. mmonreal@ns.hugtip.scs.es
M
M
Monreal
L
L
Zacharski
J A
JA
Jiménez
J
J
Roncales
B
B
Vilaseca
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D001835:Body Weight; D001932:Brain Neoplasms / Q000556:secondary; D015331:Cohort Studies; D017985:Dalteparin / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy; D013921:Thrombocytopenia / Q000150:complications; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017985:Dalteparin