title: Cancer patients requiring interruption of long-term warfarin because of surgery or chemotherapy induced thrombocytopenia: the use of fixed sub-therapeutic doses of low-molecular weight heparin.
abstract: No data are available regarding the management of cancer patients requiring interruption of long-term vitamin-K antagonist (VKA) therapy. For this purpose, we tested the efficacy and safety of fixed doses of low-molecular weight heparin (LMWH) in substitution of VKA because of invasive procedures or chemotherapy-induced thrombocytopenia. In cancer patients on VKA, therapy was discontinued 5 ± 1 days before surgery or chemotherapy. Heparin was given at prophylactic dosage in patients at low risk and at fixed subtherapeutic doses (3,800 or 4,000 UI anti-FXa, b.i.d.) in those at high-risk for thrombosis. LMWH was reinitiated 12 hr after surgery and VKA the day after. In patients receiving chemotherapy, LMWH was reinitiated 12/24 hr after obtaining a stable platelet count ≥ 30,000 mmc(3) and VKA after a stable platelet count ≥ 50,000 mmc(3) . Thromboembolism and major bleeding events were recorded from the time of VKA suspension to 30 ± 2 days postprocedure or until the next chemotherapy. Overall, 156 patients (56.4% at low risk and 43.5% at high risk for thrombosis) were enrolled; 34.6% underwent major surgery, 40.4% nonmajor surgery, and 25% chemotherapy. Thrombotic events occurred in five patients [3.2%, 95% confidence interval (CI): 1.41-7.27], four belonging to the high-risk and one to the low-risk group. Major bleeding occurred in five patients (3.2%, 95 CI: 1.41-7.27), all belonging to the high-risk group (three during major surgery and two during chemotherapy). In conclusion, LMWH given at fixed subtherapeutic is a feasible and relatively safe approach for bridging therapy in cancer patients on long-term VKA.
authors.affiliation: Cattedra ed U.O. di Ematologia con trapianto, Dipartimento di Medicina Interna e specialistica (DIMIS), Azienda Ospedaliera Universitaria Policlinico P. Giaccone, Università di Palermo, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Saccullo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Malato
authors.forename: Simona
authors.initials: S
authors.lastname: Raso
authors.forename: Marco
authors.initials: M
authors.lastname: Santoro
authors.forename: Valentina
authors.initials: V
authors.lastname: Zammit
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casuccio
authors.forename: Sergio
authors.initials: S
authors.lastname: Siragusa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D013921:Thrombocytopenia / Q000139:chemically induced; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin