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I read with interest the excellent recent Original Investigation by Meyer et al¹ comparing LMWH and warfarin for secondary prevention of VTE in patients with cancer.

Since LMWHs are convenient and safe for initial therapy, it is only natural that they are being evaluated as an alternative to oral anticoagulants for long-term therapy in both cancer and noncancer patients, particularly in light of the high bleeding risk associated with warfarin use. However, the authors allude to the fact that long-term LMWH therapy may be safer than warfarin in patients with cancer, a point that is debatable.

The use of LMWHs as long-term treatment for VTE is attractive for many reasons. First, unlike oral anticoagulant therapy, LMWH treatment will not require laboratory testing.² Second, a more uniform anticoagulant response is achieved with LMWHs because diet and concomitant drugs do not influence their anticoagulative effect.² Third, the rapid onset of action and . . . [Full Text of this Article]

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