• Guy Meyer, Zora Marjanovic, Judith Valcke, Bernard Lorcerie, Yves Gruel, Philippe Solal-Celigny, Christine Le Maignan, Jean Marc Extra, Paul Cottu, and Dominique Farge.
• Department of Respiratory and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris V University, France. guy.meyer@hop.egp.ap-hop-paris.fr
• Arch Intern Med. 2002 Aug 12;162(15):1729-35.

BackgroundThe use of warfarin sodium for treating venous thromboembolism in patients with cancer is associated with a significant risk of recurrence and bleeding. The use of low-molecular-weight heparin sodium for secondary prevention of venous thromboembolism in cancer patients may reduce the complication rate.ObjectiveTo determine whether a fixed dose of subcutaneous low-molecular-weight heparin is superior to oral warfarin for the secondary prophylaxis of venous thromboembolism in patients with cancer and venous thromboembolism.MethodsIn a randomized, open-label multicenter trial performed between April 1995 and March 1999, we compared subcutaneous enoxaparin sodium (1.5 mg/kg once a day) with warfarin given for 3 months in 146 patients with venous thromboembolism and cancer.Main Outcome MeasureA combined outcome event defined as major bleeding or recurrent venous thromboembolism within 3 months.ResultsOf the 71 evaluable patients assigned to receive warfarin, 15 (21.1%; 95% confidence interval [CI], 12.3%-32.4%) experienced one major outcome event compared with 7 (10.5%) of the 67 evaluable patients assigned to receive enoxaparin (95% CI, 4.3%-20.3%; P =.09). There were 6 deaths owing to hemorrhage in the warfarin group compared with none in the enoxaparin group. In the warfarin group, 17 patients (22.7%) died (95% CI, 13.8%-33.8%) compared with 8 (11.3%) in the enoxaparin group (95% CI, 5.0%-21.0%; P =.07). No difference was observed regarding the progression of the underlying cancer or cancer-related death.ConclusionsThese results confirm that warfarin is associated with a high bleeding rate in patients with venous thromboembolism and cancer. Prolonged treatment with low-molecular-weight heparin may be as effective as oral anticoagulants and may be safer in these cancer patients.

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