Low-Molecular-Weight Heparin versus a Coumarin for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer

The standard treatment for acute venous thromboembolism consists of initial therapy with low-molecular-weight heparin or unfractionated heparin followed by long-term therapy with an oral anticoagulant.1 This approach is highly effective in most patients, but patients with cancer have a substantial risk of recurrent thromboembolism and hemorrhagic complications.2,3 Furthermore, oral anticoagulant therapy is problematic in patients with cancer. Drug interactions, malnutrition, vomiting, and liver dysfunction can lead to unpredictable levels of anticoagulation. Invasive procedures and thrombocytopenia caused by chemotherapy often require interruption of anticoagulant therapy, and poor venous access can make laboratory monitoring difficult. These limitations may contribute to the . . .