Advertisement
Journal of Clinical Oncology  
Search for:
Limit by:
  Browse by Subject or Issue
Home Search or Browse JCO My JCO Subscriptions Customer Service Site Map

Originally published as JCO Early Release 10.1200/JCO.2005.03.133 on February 7 2005

Journal of Clinical Oncology, Vol 23, No 10 (April 1), 2005: pp. 2123-2129
© 2005 American Society of Clinical Oncology.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Save to my personal folders
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, A. Y.Y.
Right arrow Articles by Levine, M. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lee, A. Y.Y.
Right arrow Articles by Levine, M. N.
Related Articles
Right arrowRelated Editorial
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Randomized Comparison of Low Molecular Weight Heparin and Coumarin Derivatives on the Survival of Patients With Cancer and Venous Thromboembolism

Agnes Y.Y. Lee, Frederick R. Rickles, Jim A. Julian, Michael Gent, Ross I. Baker, Chris Bowden, Ajay K. Kakkar, Martin Prins, Mark N. Levine

From the McMaster University; The Henderson Research Centre, Hamilton, ON, Canada; The George Washington University and the Children's National Medical Center, Washington, DC; University of Western Australia, Perth, Australia; Pfizer Inc, New York, NY; Imperial College, London, United Kingdom; and Academic Hospital of Maastricht, Maastricht, the Netherlands

Address reprint requests to Mark N. Levine, MD, Hamilton Health Science, Henderson Hospital, Room 9, 90 Wing, 711 Concession St, Hamilton, ON L8V 1C3, Canada; e-mail: mlevine{at}mcmaster.ca

PURPOSE: Experimental studies and indirect clinical evidence suggest that low molecular weight heparins may have antineoplastic effects. We investigated the influence of a low molecular weight heparin dalteparin on the survival of patients with active cancer and acute venous thromboembolism.

PATIENTS AND METHODS: Survival data were examined in a posthoc analysis in patients with solid tumors and venous thromboembolism who were randomly assigned to dalteparin or a coumarin derivative for 6 months in a multicenter, open-label, randomized, controlled trial. All-cause mortality at 12 months was compared between treatment groups in patients with and without metastatic malignancy. The effect of dalteparin on survival was compared between the two patient subgroups.

RESULTS: During the 12-month follow-up period, 356 of 602 patients with solid tumors and acute venous thromboembolism died. Among patients without metastatic disease, the probability of death at 12 months was 20% in the dalteparin group, as compared with 36% in the oral anticoagulant group (hazard ratio, 0.50; 95% CI, 0.27 to 0.95; P = .03). In patients with metastatic cancer, no difference in mortality between the treatment groups was observed (72% and 69%, respectively; hazard ratio, 1.1; 95% CI, 0.87 to 1.4; P = .46). The observed effects of dalteparin on survival were statistically significantly different between patients with and without metastatic disease (P = .02).

CONCLUSION: The use of dalteparin relative to coumarin derivatives was associated with improved survival in patients with solid tumors who did not have metastatic disease at the time of an acute venous thromboembolic event. Additional studies are warranted to investigate these findings.

Supported by a New Investigator Award from the Canadian Institutes of Health Research/Rx&D Research Program (A.Y.Y.L). M.N.L. is the Buffett Taylor Chair in Breast Cancer Research, McMaster University, Hamilton, Ontario, Canada.

Presented in part as a poster at the 39th Annual Meeting of the American Society of Clinical Oncology, May 31-June 3, 2003, Chicago, IL.

Authors' disclosures of potential conflicts of interest are found at the end of this article.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?

Related Editorial

  • Antithrombotic Therapy in Cancer
    Nicholas R. Lemoine
    JCO 2005 23: 2119-2120 [Full Text]


This article has been cited by other articles:


Home page
 JCOHome page
N. M. Kuderer, T. L. Ortel, and C. W. Francis
Impact of Venous Thromboembolism and Anticoagulation on Cancer and Cancer Survival
J. Clin. Oncol., October 10, 2009; 27(29): 4902 - 4911.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
A. A. Khorana
Cancer and thrombosis: implications of published guidelines for clinical practice
Ann. Onc., October 1, 2009; 20(10): 1619 - 1630.
[Abstract] [Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
B. BABU and T. L. CARMAN
Cancer and clots: All cases of venous thromboembolism are not treated the same
Cleveland Clinic Journal of Medicine, February 1, 2009; 76(2): 129 - 135.
[Abstract] [Full Text] [PDF]

Home page
 Am Soc Clin Oncol Ed BookHome page
C. W. Francis and N. Kuderer
Effects of Anticoagulants on Survival for Patients with Cancer
ASCO Educational Book, January 1, 2009; 2009(1): 326 - 330.
[Abstract] [Full Text] [PDF]

Home page
 BloodHome page
C. Ay, R. Simanek, R. Vormittag, D. Dunkler, G. Alguel, S. Koder, G. Kornek, C. Marosi, O. Wagner, C. Zielinski, et al.
High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)
Blood, October 1, 2008; 112(7): 2703 - 2708.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, A. Torbicki, A. Perrier, S. Konstantinides, G. Agnelli, N. Galie, P. Pruszczyk, F. Bengel, A. J.B. Brady, D. Ferreira, et al.
Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)
Eur. Heart J., September 2, 2008; 29(18): 2276 - 2315.
[Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
M. Carrier, G. Le Gal, P. S. Wells, D. Fergusson, T. Ramsay, and M. A. Rodger
Systematic Review: The Trousseau Syndrome Revisited: Should We Screen Extensively for Cancer in Patients with Venous Thromboembolism?
Ann Intern Med, September 2, 2008; 149(5): 323 - 333.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
D. L. Ornstein
A Nickel's Worth of Cancer
Ann Intern Med, September 2, 2008; 149(5): 350 - 352.
[Full Text] [PDF]

Home page
 Arch DermatolHome page
P. Redondo
The Hidden Face of Venous Malformations: A Multidisciplinary Therapeutic Approach
Arch Dermatol, July 1, 2008; 144(7): 922 - 926.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. Nguyen, S.-J. Lee, E. Libby, and C. Verschraegen
Rate of Thromboembolic Events in Mesothelioma
Ann. Thorac. Surg., March 1, 2008; 85(3): 1032 - 1038.
[Abstract] [Full Text] [PDF]

Home page
 Arterioscler. Thromb. Vasc. Bio.Home page
P. L. Gross and J. I. Weitz
New Anticoagulants for Treatment of Venous Thromboembolism
Arterioscler Thromb Vasc Biol, March 1, 2008; 28(3): 380 - 386.
[Abstract] [Full Text] [PDF]

Home page
 Am Soc Clin Oncol Ed BookHome page
A. Falanga, A. Y. Y. Lee, M. B. Streiff, and G. H. Lyman
Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer
ASCO Educational Book, January 1, 2008; 2008(1): 258 - 268.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
G. H. Lyman, A. A. Khorana, A. Falanga, D. Clarke-Pearson, C. Flowers, M. Jahanzeb, A. Kakkar, N. M. Kuderer, M. N. Levine, H. Liebman, et al.
American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer
J. Clin. Oncol., December 1, 2007; 25(34): 5490 - 5505.
[Abstract] [Full Text] [PDF]

Home page
 FASEB J.Home page
N. Hostettler, A. Naggi, G. Torri, R. Ishai-Michaeli, B. Casu, I. Vlodavsky, and L. Borsig
P-selectin- and heparanase-dependent antimetastatic activity of non-anticoagulant heparins
FASEB J, November 1, 2007; 21(13): 3562 - 3572.
[Abstract] [Full Text] [PDF]

Home page
 BloodHome page
A. Varki
Trousseau's syndrome: multiple definitions and multiple mechanisms
Blood, September 15, 2007; 110(6): 1723 - 1729.
[Abstract] [Full Text] [PDF]

Home page
 J Oncol Pharm PractHome page
J. Nishioka and S. Goodin
Low-molecular-weight heparin in cancer-associated thrombosis: treatment, secondary prevention, and survival
Journal of Oncology Pharmacy Practice, June 1, 2007; 13(2): 85 - 97.
[Abstract] [PDF]

Home page
 Eur Heart JHome page
R. De Caterina, S. Husted, L. Wallentin, G. Agnelli, F. Bachmann, C. Baigent, J. Jespersen, S. D. Kristensen, G. Montalescot, A. Siegbahn, et al.
Anticoagulants in heart disease: current status and perspectives
Eur. Heart J., April 10, 2007; (2007) ehl492v1.
[Full Text] [PDF]

Home page
 Neuro Oncol DukeHome page
R. Simanek, R. Vormittag, M. Hassler, K. Roessler, M. Schwarz, C. Zielinski, I. Pabinger, and C. Marosi
Venous thromboembolism and survival in patients with high-grade glioma
Neuro-oncol, April 1, 2007; 9(2): 89 - 95.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
G Meyer
Does low-molecular-weight heparin influence cancer-related mortality?
Ann. Onc., March 1, 2007; 18(3): 609 - 610.
[Full Text] [PDF]

Home page
 JCOHome page
H. K. Chew, T. Wun, D. J. Harvey, H. Zhou, and R. H. White
Incidence of Venous Thromboembolism and the Impact on Survival in Breast Cancer Patients
J. Clin. Oncol., January 1, 2007; 25(1): 70 - 76.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
G. Ferretti, E. Bria, D. Giannarelli, P. Carlini, A. Felici, M. Mandala, P. Papaldo, A. Fabi, M. Ciccarese, F. Cuppone, et al.
Is Recurrent Venous Thromboembolism After Therapy Reduced by Low-Molecular-Weight Heparin Compared With Oral Anticoagulants?
Chest, December 1, 2006; 130(6): 1808 - 1816.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
G Ferretti, E Bria, D Giannarelli, P Carlini, A Felici, M Mandala, P Papaldo, A Fabi, M Ciccarese, and F Cognetti
Does low-molecular-weight heparin influence cancer-related mortality?
Ann. Onc., October 1, 2006; 17(10): 1604 - 1606.
[Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
A Fennerty
Venous thromboembolic disease and cancer.
Postgrad. Med. J., October 1, 2006; 82(972): 642 - 648.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
E. A Nutescu, A. K Wittkowsky, P. P Dobesh, D. W Hawkins, and W. E Dager
Choosing the Appropriate Antithrombotic Agent for the Prevention and Treatment of VTE: A Case-Based Approach
Ann. Pharmacother., September 1, 2006; 40(9): 1558 - 1570.
[Abstract] [Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
K. Altundag, O. Altundag, M. A. Atik, C. Boruban, M. B. Altundag, and S. Turen
Recent Findings for Anti-Metastatic Potential of Heparin
Clinical and Applied Thrombosis/Hemostasis, July 1, 2006; 12(3): 376 - 377.
[PDF]

Home page
 JCOHome page
A. Alcalay, T. Wun, V. Khatri, H. K. Chew, D. Harvey, H. Zhou, and R. H. White
Venous Thromboembolism in Patients With Colorectal Cancer: Incidence and Effect on Survival
J. Clin. Oncol., March 1, 2006; 24(7): 1112 - 1118.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
L. Y. Han, C. N. Landen Jr, A. A. Kamat, A. Lopez, D. P. Bender, P. Mueller, R. Schmandt, D. M. Gershenson, and A. K. Sood
Preoperative Serum Tissue Factor Levels Are an Independent Prognostic Factor in Patients With Ovarian Carcinoma
J. Clin. Oncol., February 10, 2006; 24(5): 755 - 761.
[Abstract] [Full Text] [PDF]

Home page
 Cancer Res.Home page
H. Laubli, J. L. Stevenson, A. Varki, N. M. Varki, and L. Borsig
L-Selectin Facilitation of Metastasis Involves Temporal Induction of Fut7-Dependent Ligands at Sites of Tumor Cell Arrest
Cancer Res., February 1, 2006; 66(3): 1536 - 1542.
[Abstract] [Full Text] [PDF]

Home page
 ASH Education BookHome page
A. Y. Y. Lee
Thrombosis and Cancer: The Role of Screening for Occult Cancer and Recognizing the Underlying Biological Mechanisms
Hematology, January 1, 2006; 2006(1): 438 - 443.
[Abstract] [Full Text] [PDF]

Home page
 BloodHome page
P. Prandoni
How I treat venous thromboembolism in patients with cancer
Blood, December 15, 2005; 106(13): 4027 - 4033.
[Abstract] [Full Text] [PDF]

Home page
 Am J Health Syst PharmHome page
S. Goodin
Selecting an anticoagulant for recurrent venous thromboembolism in cancer
Am. J. Health Syst. Pharm., November 15, 2005; 62(22_Supplement_5): S10 - S13.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
K. Altundag, O. Altundag, and M. A. Atik
Heparin and CXCL12 Dimerization
J. Clin. Oncol., October 1, 2005; 23(28): 7248 - 7248.
[Full Text] [PDF]

Home page
 JCOHome page
M. N. Levine, A. Y.Y. Lee, and A. K. Kakkar
In Reply:
J. Clin. Oncol., October 1, 2005; 23(28): 7250 - 7250.
[Full Text] [PDF]

Home page
 JCOHome page
G. Ferretti, E. Bria, D. Giannarelli, P. Carlini, A. Felici, M. Mandala, P. Papaldo, C. Nistico, A. Fabi, F. Cuppone, et al.
Low-Molecular-Weight Heparin Versus Oral Anticoagulant Therapy for the Long-Term Treatment of Symptomatic Venous Thromboembolism: Is There Any Difference in Cancer-Related Mortality?
J. Clin. Oncol., October 1, 2005; 23(28): 7248 - 7250.
[Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
J. L. Stevenson, S. H. Choi, and A. Varki
Differential Metastasis Inhibition by Clinically Relevant Levels of Heparins--Correlation with Selectin Inhibition, Not Antithrombotic Activity
Clin. Cancer Res., October 1, 2005; 11(19): 7003 - 7011.
[Abstract] [Full Text] [PDF]

Home page
 JWatch GeneralHome page
Low-Molecular-Weight Heparin to Treat Cancer?
Journal Watch (General), April 26, 2005; 2005(426): 3 - 3.
[Full Text]


About
JCO		 Editorial
Roster		 Advertising
Information		 Librarians &
Institutions		 Rights &
Permissions		 PDA Services

Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
Terms and Conditions of Use
  HighWire Press HighWire Press™ assists in the publication of JCO Online