This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zacharski, L. R. Articles by Monreal, M. Search for Related Content PubMed PubMed Citation Articles by Zacharski, L. R. Articles by Monreal, M.

Warfarin Versus Low-Molecular-Weight Heparin Therapy in Cancer Patients

^a VA Medical and Regional Office Center, White River Junction, Vermont, USA; ^b Department of Medical and Surgical Sciences, University of Padua, Padova, Italy; ^c Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

Correspondence: Leo Zacharski, M.D., VA Medical and Regional Office Center, 215 North Main Street, White River Junction, Vermont 05009, USA. Telephone: 802-296-5149; Fax: 802-296-6308; e-mail: Leo.R.Zacharski{at}dartmouth.edu

The association between cancer and venous thromboembolism (VTE) is well established. Importantly, VTE is a significant cause of mortality in cancer patients. Although long-term warfarin (Coumadin^TM; Bristol-Myers Squibb; New York, NY) therapy is the mainstay of treatment for cancer patients with VTE, there are many practical problems with its use in this population. In particular, achieving therapeutic drug levels is difficult in cancer patients due to the increased risk of drug interactions, malnutrition, vomiting, and liver dysfunction in these patients. Moreover, cancer patients are at an increased risk of adverse effects of warfarin therapy. In contrast, low-molecular-weight heparins (LMWHs) are associated with a lower risk of adverse events compared with warfarin in patients with cancer. These agents also offer practical advantages compared with warfarin, including more predictable anticoagulant effects and ease of administration in addition to possible antineoplastic effects. Several LMWHs have demonstrated superior efficacy to warfarin in the secondary prevention of VTE. In particular, the LMWH, dalteparin (Fragmin^®; Pfizer; New York, NY), has recently been shown to have superior efficacy to warfarin in a large trial of patients with cancer and VTE without increasing the risk of bleeding. A randomized trial of dalteparin has also shown improved response rates and survival in patients with small cell lung cancer. In view of the availability of more effective and reliable alternatives to warfarin therapy in cancer patients, it is appropriate to reassess the role of warfarin therapy in patients with cancer and VTE. Further evaluation of the LMWHs for effects on cancer outcome is indicated.

Key Words. Warfarin • Cancer • Low-molecular-weight heparin • Dalteparin

This article has been cited by other articles:

				L. S. Abbott, M. Deevska, C. V. Fernandez, D. Dix, V. E. Price, H. Wang, L. Parker, M. Yhap, C. Fitzgerald, D. R. Barnard, et al. The impact of prophylactic fresh-frozen plasma and cryoprecipitate on the incidence of central nervous system thrombosis and hemorrhage in children with acute lymphoblastic leukemia receiving asparaginase Blood, December 10, 2009; 114(25): 5146 - 5151. [Abstract] [Full Text] [PDF]

				C. A. Engman and L. R. Zacharski Low Molecular Weight Heparins as Extended Prophylaxis Against Recurrent Thrombosis in Cancer Patients J Natl Compr Canc Netw, August 1, 2008; 6(7): 637 - 645. [Abstract] [PDF]