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Cancer patients requiring interruption of long‐term warfarin because of surgery or chemotherapy induced thrombocytopenia: The use of fixed sub‐therapeutic doses of low‐molecular weight heparin
Author(s) -
Saccullo Giorgia,
Malato Alessandra,
Raso Simona,
Santoro Marco,
Zammit Valentina,
Casuccio Alessandra,
Siragusa Sergio
Publication year - 2012
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23122
Subject(s) - medicine , vitamin k antagonist , chemotherapy , low molecular weight heparin , warfarin , thrombosis , surgery , heparin , anesthesia , atrial fibrillation
No data are available regarding the management of cancer patients requiring interruption of long‐term vitamin‐K antagonist (VKA) therapy. For this purpose, we tested the efficacy and safety of fixed doses of low‐molecular weight heparin (LMWH) in substitution of VKA because of invasive procedures or chemotherapy‐induced thrombocytopenia. In cancer patients on VKA, therapy was discontinued 5 ± 1 days before surgery or chemotherapy. Heparin was given at prophylactic dosage in patients at low risk and at fixed subtherapeutic doses (3,800 or 4,000 UI anti‐FXa, b.i.d.) in those at high‐risk for thrombosis. LMWH was reinitiated 12 hr after surgery and VKA the day after. In patients receiving chemotherapy, LMWH was reinitiated 12/24 hr after obtaining a stable platelet count ≥ 30,000 mmc 3 and VKA after a stable platelet count ≥ 50,000 mmc 3 . Thromboembolism and major bleeding events were recorded from the time of VKA suspension to 30 ± 2 days postprocedure or until the next chemotherapy. Overall, 156 patients (56.4% at low risk and 43.5% at high risk for thrombosis) were enrolled; 34.6% underwent major surgery, 40.4% nonmajor surgery, and 25% chemotherapy. Thrombotic events occurred in five patients [3.2%, 95% confidence interval (CI): 1.41–7.27], four belonging to the high‐risk and one to the low‐risk group. Major bleeding occurred in five patients (3.2%, 95 CI: 1.41–7.27), all belonging to the high‐risk group (three during major surgery and two during chemotherapy). In conclusion, LMWH given at fixed subtherapeutic is a feasible and relatively safe approach for bridging therapy in cancer patients on long‐term VKA. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc.