0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Is Low-Molecular-Weight Heparin Safer Than Warfarin for Secondary Prevention of Venous Thromboembolism in Cancer Patients?—Reply

Guy Meyer, MD; Dominique Farge, MD
Arch Intern Med. 2003;163(10):1244. doi:10.1001/archinte.163.10.1243-a.
Text Size: A A A
Published online

Extract

In reply

We thank Dr Theerman for his comments on the INR target in patients receiving oral anticoagulants. Although we agree that this treatment was associated with a high rate of bleeding in our patients, we do not agree with his suggestion of maintaining patients with acute VTE on a lower level of oral anticoagulation. Our study was designed to test a novel anticoagulant strategy (ie, long-term LMWH therapy), which has to be compared with a reference regimen. Warfarin therapy adjusted to obtain an INR of 2 to 3 is the current recommendation for treating VTE and is supported by a large body of literature.1 In addition, strong and consistent data support that low INR values are associated with a high risk of recurrent thrombosis.2 Finally, although patients with cancer are known to have an increased risk of bleeding when receiving anticoagulants, they also carry a higher risk of thromboembolic recurrences.3 In our study, the recurrence rate in the warfarin group was twice higher than in the LMWH group, and a lower-intensity warfarin therapy may have resulted in an even higher rate of thromboembolic complications in this group.4 As suggested by Dr Theerman, most of the major bleeding episodes were observed at the time the INR value was greater than 3. The question is not the level of desired anticoagulation but the difficulty in maintaining the INR at a prespecified level, which appears more difficult in patients with cancer than in those without.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Resolution

Users' Guides to the Medical Literature
Clinical Scenario

brightcove.createExperiences();