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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EIn patients with active cancer and acute venous thromboembolism, tinzaparin reduced the cumulative risk of recurrent venous thromboembolism and significantly reduced the risk of symptomatic deep vein thrombosis. Full-dose tinzaparin did not increase the risk of major bleeding and was associated with a significantly decreased risk of clinically relevant nonmajor bleeding.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Erecurrent venous thromboembolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eoncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eprevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group drug\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etinzaparin\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ewarfarin\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ELong-Term Tinzaparin Treatment Versus a Vitamin K Antagonist (Warfarin) for the Treatment of Venous Thromboembolism (VTE) in Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT01130025\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EVarious strategies have been tested to prevent recurrent venous thromboembolism (VTE) in patients with cancer, including warfarin and low-molecular-weight heparins (LMWH), such as enoxaparin, dalteparin, and tinzaparin. Agnes Y. Y. Lee, MD, MSc, University of British Columbia, Vancouver, British Columbia, Canada, presented the safety and efficacy results of the Long-term Tinzaparin Treatment Versus a Vitamin K Antagonist (Warfarin) for the Treatment of Venous Thromboembolism (VTE) in Cancer study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01130025\u0026amp;atom=%2Fspmdc%2F14%2F55%2F12.atom\u0022\u003ENCT01130025\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe primary objective was to study the efficacy of tinzaparin in preventing recurrent VTE in patients with active cancer. Although Prof Lee did not report the secondary objectives, they included the safety of tinzaparin for long-term use, the incidence and severity of postthrombotic syndrome, the assessment of quality of life, and an estimate of health care resource utilization.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn this prospective open-label trial, patients were randomly assigned to tinzaparin, 175 IU\/kg, once daily (n\u2009=\u2009449) or to warfarin (target international normalized ratio, 2 to 3) plus initial tinzaparin, 175 IU\/kg, for 5 to 10 days (n\u2009=\u2009451).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EStructured interviews by clinic visits and telephone were used to determine if outcome events occurred. The primary composite efficacy end point included symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE), fatal PE, incidental proximal DVT, and incidental proximal PE. Key safety end points included major bleeding, clinically relevant nonmajor bleeding, and overall mortality. Patients were well matched for previous VTE, type of cancer, metastatic disease (a little over half of patients in each group), active cancer treatment (a little over half of patients in each group), and symptomatic PE or DVT (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The most frequent types of cancer were gynecologic, gastrointestinal, lung, hematologic, and genitourinary.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11632\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11632\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11632\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ESelected Patient Characteristics\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003ERecurrent VTE occurred in 7.2% of patients on tinzaparin and 10.5% of patients on warfarin (time within therapeutic range, 47%) for a 35% risk reduction (HR, 0.65; 95% CI, 0.41 to 1.03; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.007). In prespecified efficacy analyses, tinzaparin significantly reduced symptomatic DVT by 52% (HR, 0.48; 95% CI, 0.24 to 0.96; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u20090.04). Symptomatic PE and incidental VTE were low in both groups. Fatal PEs were similar in both groups, with 17 patients in each group. According to the per-protocol analysis, recurrent VTE was reduced 38% (HR, 0.62; 95% CI, 0.38 to 1.00).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThere were no differences in major bleeding or overall mortality between groups. Tinzaparin significantly reduced clinically relevant nonmajor bleeding by 31% (HR, 0.69; 95% CI, 0.49 to 0.96; \u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.03). Overall mortality at day 180 was 34.2% in the tinzaparin group and 32.2% in warfarin group.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThis is the largest randomized controlled trial studying the treatment of cancer-associated thrombosis, and it provides confirmatory data for the improved efficacy of LMWH over warfarin. Full-dose tinzaparin did not increase major bleeding and reduced clinically relevant nonmajor bleeding. This is also the first trial to document the prevalence and incidence of incidental thrombosis in cancer. Although quality-of-life results were not reported here, Prof Lee observed that patients on LMWH have less anxiety about being in the therapeutic range, are easier to manage, and have no drug interactions with diet or chemotherapy. Finally, global participation in the study led to the enrollment of Asian patients, a population not included in previous trials.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/55\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo9j3\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo9j3\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}