Comparison of low-molecular-weight heparin and warfarin for secondary prevention of venous thromboembolism in patients with cancer. A randomized controlled study

Meyer, Guy; Marjanovic, Zora; Valcke, Judith

doi:10.1016/s1062-1458(02)00998-4

Cited by 236 publications

(375 citation statements)

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“…Seven randomised trials and eight meta-analyses have compared the benefi t-to-risk ratio of LMWH versus 25,42,43 and was at lower risk of recurrent VTE, as indicated by the lower than expected recurrence of VTE in the tinzaparin followed by the VKA group. The updated search identifi ed one study 47 that assessed extended LMWH treatment in patients with cancer and residual VTE after an initial 6 months of nadroparin (97 IU/kg twice a day).…”

Section: Early Maintenance (10 Days To 3 Months) and Long-term (Beyonmentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

388

434

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Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specifi c subgroups of patients with cancer.

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Section: Early Maintenance (10 Days To 3 Months) and Long-term (Beyonmentioning

confidence: 99%

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge

Bounameaux

Brenner

et al. 2016

The Lancet Oncology

388

434

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“…In the second study, Meyer et al compared enoxaparin sodium (1.5 mg·kg -1 once daily) with VKA given for three months in 146 patients. 32 The rate of major outcome event (defined as major bleeding or recurrent VTE within three months) was 21.1% in patients assigned to receive VKA compared with 10.5% in patients assigned to receive enoxaparin (P = 0.09). The trend in favour of enoxaparin was accounted for, mainly, by a higher rate of major bleeding in the VKA group (16% vs 7.0%, P = 0.09).…”

Section: Low Molecular Weight Heparin For the Long-term Treatment Of mentioning

confidence: 93%

“…30 Two recent randomized clinical trials have assessed the potential benefit of long-term treatment of acute VTE with sc LMWH as an alternative approach to VKA in patients with cancer and acute DVT or PE. 31,32 In a study including 676 patients, sc dalteparin alone for six months (200 IU·kg -1 once daily for one month, followed by 150 IU·kg -1 once daily for five months) was compared with dalteparin 200 IU·kg -1 body weight sc once daily for five to seven days, followed by oral treatment with VKA for six months (target INR ranging from 2.0 to 3.0). 31 During the six-month study period, recurrent VTE occurred in 15.7% of patients who received the VKA treatment, compared with 8.0% of those who received a LMWH (dalteparin) alone (P = 0.002).…”

Section: Low Molecular Weight Heparin For the Long-term Treatment Of mentioning

confidence: 99%

Management of venous thromboembolism

Moerloose

Samama

Motte

2006

Can J Anesth/J Can Anesth

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“…[12][13][14] Studies assessing the safety of long-term LMWH against oral vitamin K antagonists (VKAs) or novel anticoagulants in cancer or other populations were designed to address more common side effects: the risk of bleeding and thrombocytopenia. [15][16][17][18][19][20][21][22][23][24][25][26][27][28] The adverse effects of long-term LMWH on bone in terms of increased risks of fractures (i.e., clinically most important but rare outcomes) and bone loss are less commonly researched and unclear. The effects of LMWH on bone were mainly studied in the pregnant population.…”

Section: Introductionmentioning

confidence: 99%

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

et al. 2016

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BACKGROUND: Adults who require long-term anticoagulation with low-molecular-weight heparin (LMWH) such as cancer patients or the elderly may be at increased risk of fractures. OBJECTIVE: To determine the effects of LMWH therapy of at least 3 months' duration on fractures and bone mineral density (BMD) in non-pregnant adult populations. METHODS: We systematically reviewed electronic databases (e.g., MEDLINE, EMBASE), conferences and bibliographies until June 2015 and included comparative studies in non-pregnant adult populations that examined the effects of LMWH (≥3 months) on fractures and BMD. We synthesized evidence qualitatively and used random-effects meta-analysis to quantify the effect of LMWH on fractures. RESULTS: Sixteen articles reporting 14 studies were included: 10 clinical trials (n = 4865 participants) and four observational cohort studies (3 prospective, n = 221; 1 retrospective, n = 30). BMD and fractures were secondary outcomes in the majority of trials, while they were primary outcomes in the majority of observational studies. In participants with venous thromboembolism and underlying cardiovascular disease or cancer (5 RCTs, n = 2280), LMWH for 3-6 months did not increase the relative risk of all fractures at 6-12 months compared to unfractionated heparin, oral vitamin K antagonists or placebo [pooled risk ratio (RR) = 0.58, 95 % CI: 0.23-1.43; I 2 = 12.5 %]. No statistically significant increase in the risk of fractures at 6-12 months was found for cancer patients (RR = 1.08, 95 % CI: 0.31-3.75; I 2 = 4.4 %). Based on the data from two prospective cohort studies (n = 166), LMWH for 3-24 months decreased mean BMD by 2.8-4.8 % (depending on the BMD site) compared to mean BMD decreases of 1.2-2.5 % with oral vitamin K antagonists. CONCLUSIONS: LMWH for 3-6 months may not increase the risk of fractures, but longer exposure for up to 24 months may adversely affect BMD. Clinicians should consider monitoring BMD in adults on long-term LMWH who are at increased risk of bone loss or fracture.

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Comparison of low-molecular-weight heparin and warfarin for secondary prevention of venous thromboembolism in patients with cancer. A randomized controlled study

Cited by 236 publications

References 0 publications

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Management of venous thromboembolism

Effects of Long-Term Low-Molecular-Weight Heparin on Fractures and Bone Density in Non-Pregnant Adults: A Systematic Review With Meta-Analysis

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