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)?
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: diagnosis, management and thrombophilia testing
Number
CG144
Date issued
June 2012

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  
Last Reviewed 10/07/2012