Minidose Warfarin Prophylaxis for Catheter-Associated Thrombosis in Cancer Patients: Can It Be Safely Associated With Fluorouracil-Based Chemotherapy?

Masci, Giovanna; Magagnoli, Massimo; Zucali, Paolo Andrea; Castagna, Luca; Carnaghi, Carlo; Sarina, Barbara; Pedicini, Vittorio; Fallini, Monica; Santoro, Armando

doi:10.1200/jco.2003.02.042

Cited by 90 publications

(58 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Supporting this notion, we found that the vast majority of recurrent VTEs were treated with LMWH monotherapy. The desire to avoid drug-drug interactions in patients receiving chemotherapy and warfarin may also explain in part the preference for LMWH monotherapy in these patients [20,24].…”

Section: Discussionmentioning

confidence: 99%

“…This is an important outcome because cancer patients with VTE are more likely than a non-cancer patient to experience a recurrent VTE, and recurrent VTE is a substantial burden on both the patient and the healthcare system [19]. Furthermore, warfarin therapy interacts with many chemotherapy agents [20] and INR control is more difficult in cancer patients [21]. Cancer patients frequently require invasive procedures, and coordination of warfarin therapy interruption for these procedures is notoriously challenging [5].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

et al. 2012

View full text Add to dashboard Cite

Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed.Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Indeed thromboprophylaxis appears to be safe, even in patients with haematological malignancies who often have concurrent severe thrombocytopenia (Boraks et al, 1998;Cortelezzi et al, 2005). However, it is important to recognise that minidose warfarin (1 mg day À1 ) can have a significant effect on the prothrombin time in cancer patients (Heaton et al, 2002;Masci et al, 2003;Mismetti et al, 2003;Magagnoli et al, 2005). The aetiology of this increased prothrombin time is multifactorial, and includes anorexia and liver metastases (Magagnoli et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

et al. 2006

View full text Add to dashboard Cite

Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis.

show abstract

“…On the basis of some studies that showed that minidose of warfarin (1 mg/ day) reduces catheter-related thrombosis without inducing alterations in the prothrombin time (PT) or activated partial thromboplastin time (aPTT) or causes bleeding [8][9][10][11], all patients undergoing high-dose chemotherapy were given prophylaxis with minidose warfarin in our bone-marrow transplantation (BMT) unit.…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis of central venous catheter‐related thrombosis with minidose warfarin in patients treated with high‐dose chemotherapy and peripheral‐blood stem‐cell transplantation: Retrospective analysis of 228 cancer patients

et al. 2005

Self Cite

View full text Add to dashboard Cite

Patients with a central venous catheter (CVC) undergoing high-dose chemotherapy (HDC) followed by peripheral-blood stem-cell transplantation (PBSCT) for malignancies are at high risk of thrombosis, but the use of anti-coagulant prophylaxis remains debatable in this setting of patients. We analyzed the efficacy and the safety of minidose warfarin in 228 patients in whom CVCs had been placed and who had received 292 HDC courses of therapy. The catheters remained in place for a mean of 173 (range 40-298) days. All patients received prophylactic oral warfarin in the fixed dose of 1 mg/day starting on the day of CVC insertion. Prophylaxis was interrupted during aplasia when platelet counts fell below 50,000/dL. There were no toxic deaths related to the prophylaxis. Overall there were 4 thrombotic events. Three occurrences were directly related to the catheter, while the remaining event was a deep saphenous-vein thrombosis. A number of potential predictive factors were analyzed for their impact on thrombotic events without finding any significant correlation. Four episodes of bleeding occurred, with each of these individuals having a normal INR but a platelet count below 50,000/dL. Minidose warfarin is effective and safe to use for preventing thrombotic events in this setting of patients. Am.

show abstract

Minidose Warfarin Prophylaxis for Catheter-Associated Thrombosis in Cancer Patients: Can It Be Safely Associated With Fluorouracil-Based Chemotherapy?

Abstract: A high incidence of INR abnormalities was observed in our cohort of patients, especially those treated with FOLFOX regimen. Clinicians should be aware of this interaction and should regularly monitor the prothrombin time in patients receiving warfarin and FU.

Cited by 90 publications

References 35 publications

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

Primary thromboprophylaxis for cancer patients with central venous catheters – a reappraisal of the evidence

Prophylaxis of central venous catheter‐related thrombosis with minidose warfarin in patients treated with high‐dose chemotherapy and peripheral‐blood stem‐cell transplantation: Retrospective analysis of 228 cancer patients

Contact Info

Product

Resources

About