title: Recurrence of Venous Thromboembolism in Patients With Cancer Treated With Warfarin.
abstract: Venous thromboembolism (VTE) is a common complication in patients with cancer. Previous randomized studies have demonstrated that the rates of recurrent VTE are lower in patients treated with low-molecular-weight heparin compared to warfarin. We performed a retrospective analysis of 236 patients with cancer managed by a dedicated oncology anticoagulation management service to compare "real-world" rates of recurrent VTE and bleeding in patients treated with warfarin versus parenteral anticoagulants. Initial anticoagulant regimen included a parenteral agent with transition to warfarin in 132 (55.9%) patients, enoxaparin in 53 (22.5%), dalteparin in 37 (15.7%), and fondaparinux in 14 (5.9%). Taking into account the competing risk of death, cumulative incidence of VTE recurrence at 6 months was 4.0% with warfarin, 10.3% with enoxaparin, 3.0% with dalteparin, and 7.7% with fondaparinux (P = .004). Bleeding complications occurred in 10.6% of patients on warfarin, 17.0% on enoxaparin, 27.0% on dalteparin, and 14.3% on fondaparinux (P = .089). In a dedicated anticoagulation clinic, specific for patients with cancer, warfarin may be an acceptable treatment for first thrombotic events in patients with cancer.
authors: Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Ariela L
authors: AL
authors: Marshall
authors: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Federico
authors: F
authors: Campigotto
authors: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors: Donna
authors: D
authors: Neuberg
authors: Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Hematology Division, Brigham and Women's Hospital, Boston, MA, USA.
authors: Betty
authors: B
authors: Rowe
authors: Department of Hematology and Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Hematology Division, Brigham and Women's Hospital, Boston, MA, USA jconnors@partners.org.
authors: Jean M
authors: JM
authors: Connors
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D012008:Recurrence; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; hypercoagulability; venous thromboembolism