Key result
Warfarin treatment in cancer patients was associated with a 6-month VTE recurrence rate of 4.0%, compared to 10.3% with enoxaparin, 3.0% with dalteparin, and 7.7% with fondaparinux.
Why the study?
Does warfarin compared to parenteral anticoagulants prevent recurrent VTE in patients with cancer?
Cohort (n=236)
Does warfarin compared to parenteral anticoagulants prevent recurrent VTE in patients with cancer?
In a real-world oncology anticoagulation clinic, warfarin showed a lower 6-month cumulative incidence of VTE recurrence compared to some parenteral anticoagulants, suggesting it may be an acceptable treatment option.
Answers are grounded in this paper and cite their sources.
Real-world comparison of warfarin versus parenteral agents in cancer VTE may inform practice; leaves open need for prospective validation.
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.
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Marshall et al. (2015) conducted a cohort in Venous thromboembolism in cancer (n=236). Warfarin vs. Parenteral anticoagulants (enoxaparin, dalteparin, fondaparinux) was evaluated on Cumulative incidence of VTE recurrence at 6 months (p=.004). Warfarin treatment in cancer patients was associated with a 6-month VTE recurrence rate of 4.0%, compared to 10.3% with enoxaparin, 3.0% with dalteparin, and 7.7% with fondaparinux.
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