Originally published as JCO Early Release 10.1200/JCO.2005.10.192 on March 14 2005

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Randomized Placebo-Controlled Study of Low-Dose Warfarin for the Prevention of Central Venous Catheter–Associated Thrombosis in Patients With Cancer

From the Departments of Medicine, Community Health and Epidemiology, and Radiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; Department of Oncology, Saint John Regional Hospital, Saint John, New Brunswick; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Address reprint requests to Stephen Couban, MD, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Room 417, Bethune Bldg, 1278 Tower Rd, Halifax, Nova Scotia B3H 2Y9, Canada; e-mail: stephen.couban{at}cdha.nshealth.ca

PURPOSE: In this multicenter, randomized, placebo-controlled clinical trial, we studied whether warfarin 1 mg daily reduces the incidence of symptomatic central venous catheter (CVC) –associated thrombosis in patients with cancer.

PATIENTS AND METHODS: Two hundred fifty-five patients with cancer who required a CVC for at least 7 days were randomly assigned to receive warfarin 1 mg or placebo.

RESULTS: There were 11 (4.3%) symptomatic CVC-associated thromboses among 255 patients, with no difference in the incidence of symptomatic CVC-associated thrombosis between patients taking warfarin 1 mg daily (six of 130 patients; 4.6%) and patients taking placebo (five of 125 patients; 4.0%; hazard ratio, 1.20; 95% CI, 0.37 to 3.94). Warfarin had no effect on CVC life span (84 days v 63 days in control and warfarin groups, respectively; 95% confidence limit, –16 to 55 days; P = .09), and it did not affect the number of premature CVC removals (23.2% v 25.4% in control and warfarin groups, respectively; 95% confidence limit of difference –8.34 to 12.71; P = .68) or the frequency of major bleeding episodes (2% v 0% in control and warfarin groups, respectively; P = .5, Fisher's exact test).

CONCLUSION: Symptomatic CVC-associated thrombosis in patients with cancer, although significant, is less common than previously reported. In this study, the administration of warfarin 1 mg daily did not reduce the incidence of symptomatic CVC-associated thrombosis in patients with cancer. However, the low rate of symptomatic CVC-associated thrombosis means that a much larger trial is required to address this issue definitively.

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

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  JCO 2005 23: 4006-4008 [Full Text]

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