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Individual research recommendation details

Recommendation details

Recommendation ID: CG144/3
Question: Long-term anticoagulation treatment with low molecular weight heparin versus a vitamin K antagonist in patients with VTE and active cancer:- In patients with VTE and active cancer who have had 6 months of anticoagulation treatment with low molecular weight heparin (LMWH), what is the clinical benefit (in terms of VTE recurrence rates, all-cause mortality and major bleeding) and cost effectiveness of continued anticoagulation treatment with LMWH versus a vitamin K antagonist (VKA)?
Page: 27
Any explanatory
notes (if applicable):
Why this is important:- Determining whether LMWH or a VKA should be used for anticoagulation treatment in patients with cancer beyond the initial 6 months of LMWH therapy is critically important. The current recommendation for use of LMWH for the initial 6 months is based on a systematic review that showed LMWH to be advantageous compared with VKA; however, evidence was available only up to 6 months of anticoagulation with VKA. The relative benefits of LMWH or a VKA beyond the initial 6 months are therefore unknown. An RCT is urgently needed to answer this question. The trial should recruit patients with VTE associated with cancer who have completed 6 months of LMWH treatment, in whom long-term treatment is planned, and who have no contraindications to further anticoagulation treatment with either LMWH or a VKA. Patients should be randomised to treatment with either LMWH or a VKA. The primary outcome measure should be VTE recurrence rates. Secondary outcomes should include cost effectiveness and quality of life. Such a trial will provide an evidence-based understanding of the relative benefits and risks of long-term treatment with LMWH versus long-term treatment with a VKA, inform patient and clinician choice and enable development of clear guidelines to minimise variability in care and make the best use of NHS resources.

Source guidance details

Comes from guidance: Venous thromboembolic diseases
Number: CG144
Date issued: Jun 2012

Research needed into:

Effectiveness of treatment: No
Cost of treatment: No
Implementation of treatment: No
Quality of life: No
Methods of research: No

Other details

Is this a recommendation for the use of a technology only in the context of research?: No
Is it a recommendation that suggests collection of data or the establishment of a register?: No
Recommendation priority: Unrated
Recommendation status: Research Pending
Notes: 0
Date this record updated: 10-07-2012

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.