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Is Low-Molecular-Weight Heparin Safer Than Warfarin for Secondary Prevention of Venous Thromboembolism in Cancer Patients?—Reply
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In reply
We thank Dr Theerman for his comments on the INR target in patients receiving oral anticoagulants. Although we agree that this treatment was associated with a high rate of bleeding in our patients, we do not agree with his suggestion of maintaining patients with acute VTE on a lower level of oral anticoagulation. Our study was designed to test a novel anticoagulant strategy (ie, long-term LMWH therapy), which has to be compared with a reference regimen. Warfarin therapy adjusted to obtain an INR of 2 to 3 is the current recommendation for treating VTE and is supported by a large body of literature.1 In addition, strong and consistent data support that low INR values are associated with a high risk of recurrent thrombosis.2 Finally, although patients with cancer are known to have an increased risk of bleeding when receiving anticoagulants, they also carry a higher risk of thromboembolic . . . [Full Text of this Article]
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