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Fixed‐dose low‐molecular‐weight heparin for secondary prevention of venous thromboembolism in patients with disseminated cancer: a prospective cohort study
Author(s) -
Monreal M.,
Zacharski L.,
Jiménez J. A.,
Roncales J.,
Vilaseca B.
Publication year - 2004
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2004.00853.x
Subject(s) - medicine , surgery , prospective cohort study , complication , cohort , cancer , low molecular weight heparin , heparin
Summary. Introduction : Secondary prevention of venous thromboembolism (VTE) with vitamin K antagonists is often problematic in patients with cancer. We prospectively evaluated the effectiveness and safety of long‐term subcutaneous dalteparin in a series of consecutive patients with symptomatic VTE and metastatic cancer. Patients and Methods : The study included 203 patients, aged 36–96 years. The initial treatment consisted of a 7‐day course of subcutaneous dalteparin according to body weight. Then, patients received a fixed dose of 10 000 IU dalteparin once daily for at least 3 months. In patients developing transient thrombocytopenia the dose was reduced to 5000 IU daily while the platelet count remained <50 000; and to 2500 IU daily while it remained <10 000. Patients undergoing any surgical intervention during the study were put on 5000 IU daily during the first 4 days, switching thereafter to 10 000 IU. Patients undergoing any other invasive procedure (i.e. biopsies, punctures) received a 5000 IU dose the same day, instead of 10 000 IU. Results : Eleven patients (5.4%) developed major bleeding complications (6 fatal) during the 3‐month study period, and 18 patients (8.9%) developed VTE recurrences (2 patients died). There were no higher complication rates in patients with either liver or brain metastases, nor during thrombocytopenia, surgery or invasive procedures. Conclusions : Fixed dose 10 000 IU subcutaneous dalteparin once daily for 3 months was not associated with more complications in patients with liver or brain metastases. The dose adjustment for patients with thrombocytopenia, surgery or invasive procedures was safe too.