help button home button The Oncologist http://theoncologist.alphamedpress.org/subscriptions/etoc.dtl
HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
The Oncologist, Vol. 10, No. 1, 72-79, January 2005; doi:10.1634/theoncologist.10-1-72
© 2005 AlphaMed Press

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the course for this article:
 Warfarin Versus Low Molecular Weight Heparin Therapy in Cancer Patients
Right arrow eLetters: Submit a response to this article
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article link to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Reprints/Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Zacharski, L. R.
Right arrow Articles by Monreal, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Zacharski, L. R.
Right arrow Articles by Monreal, M.

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

Leo R. Zacharskia, Paolo Prandonib, Manuel Monrealc

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 (CoumadinTM; 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






HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
THE ONCOLOGIST STEM CELLS CME ALPHAMED PRESS JOURNALS
http://theoncologist.alphamedpress.org/misc/eLetters.shtml

Copyright © 2005 by AlphaMed Press.