Among patients with active cancer and acute symptomatic venous thromboembolism (VTE), the use of full-dose tinzaparin (175 IU/kg) daily compared with warfarin for 6 months did not significantly reduce the composite measure of recurrent VTE and was not linked with reduction in overall mortality or major bleeding, according to a study published in JAMA.
Largely based on the results of a single, large trial, low-molecular-weight heparin is recommended over warfarin for the treatment of acute VTE in patients with cancer.
Researchers studied the efficacy and safety of tinzaparin versus warfarin for the treatment of acute, symptomatic VTE in patients with active cancer.
A randomized,-open-label study with blinded central adjudication outcomes was conducted. Enrolled were adult patients with active cancer and objectively documented proximal deep vein thrombosis (DVT) or pulmonary embolism, with a life expectancy greater than 6 months and without contraindications for anticoagulation.
They were followed up for 180 days and for 30 days after the last study medication dose for collection of safety data.
Patients (N = 900) received tinzaparin (175 IU/kg) once daily for 6 months versus conventional therapy with tinzaparin (175 IU/kg) once daily for 5 to 10 days followed by warfarin at a dose adjusted to maintain the international normalized ratio within the therapeutic range (2.0 to 3.0) for 6 months.
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Results showed a significantly lower rate of clinically relevant nonmajor bleeding associated with tinzaparin (49 of 449 patients for tinzaparin vs 69 of 451 patients for warfarin).
Further studies are needed to assess whether efficacy outcomes would differ in patient at higher risk of recurrent VTE.
- Lee AYY, Kamphuisen PW, Meyer G, et al. Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: a randomized clinical trial. JAMA. 2015;314(7):677-686.