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Secondary Prevention of Venous Thromboembolic Events in Patients With Active Cancer: Enoxaparin Alone Versus Initial Enoxaparin Followed by Warfarin for a 180-Day Period

Section of Hematology and Coagulation Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, sdeitcher{at}nuvelo.com

Craig M. Kessler, MD

Lombardi Cancer Center, Georgetown University Medical Center, Washington, District of Columbia

Geno Merli, MD

Division of General Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania

James R. Rigas, MD

Division of Hematology and Medical Oncology, Dartmouth Medical School, Lebanon, New Hampshire

Roger M. Lyons, MD

U.S. Oncology, San Antonio, Texas

Jawed Fareed, PhD

Loyola University Medical Center, Maywood, Illinois

This study evaluated enoxaparin alone versus initial enoxaparin followed by warfarin in secondary prevention of venous thromboembolic events in adults with active malignancy. Cancer patients (n = 122) with acute symptomatic venous thromboembolic events were randomly allocated to receive subcutaneous enoxaparin 1.0 mg/kg every 12 hours for 5 days, followed by 1.0 mg/kg daily (group 1a) or 1.5 mg/kg daily (group 1b) for 175 days, or subcutaneous enoxaparin 1.0 mg/kg every 12 hours for at least 5 days and until a stable international normalized ratio of 2 to 3 was achieved on oral warfarin begun on day 2 and continued to day 180 (group 2). There were no significant differences in major and minor bleeding rates between treatment groups. No bleeding events were intracranial or fatal. Enoxaparin treatment was feasible, generally well tolerated, and effective for a 180-day period in the secondary prevention of venous thromboembolic events in patients with active malignancy.

Key Words: Enoxaparin • Deep venous thrombosis • Malignancy

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