Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial.

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Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial. / Young, AM; Billingham, Lucinda; Begum, G; Kerr, DJ; Hughes, Ana; Rea, Daniel; Shepherd, S; Stanley, A; Sweeney, A; Wilde, J; Wheatley, Keith.

In: Lancet, Vol. 373, No. 9663, 14.02.2009, p. 567-74.

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Young, AM ; Billingham, Lucinda ; Begum, G ; Kerr, DJ ; Hughes, Ana ; Rea, Daniel ; Shepherd, S ; Stanley, A ; Sweeney, A ; Wilde, J ; Wheatley, Keith. / Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial. In: Lancet. 2009 ; Vol. 373, No. 9663. pp. 567-74.

Bibtex

@article{8e61f674f97241079478fce751f6bf21,
title = "Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial.",
abstract = "Background: The role and dose of anticoagulants in thrombosis prophylaxis for cancer patients with central venous catheters (CVCs) is controversial. Methods: 1590 cancer patients receiving chemotherapy via CVCs were randomised to no warfarin [control] vs warfarin [either daily fixed dose 1mg warfarin (FDW) or daily dose adjusted warfarin (DAW) to maintain International Normalised Ratio between 1.5 and 2.0]. Clinicians {\textquoteleft}certain{\textquoteright} of the benefit of warfarin randomised between FDW and DAW. The primary outcome measure is the incidence of radiologically proven, symptomatic catheter-related thrombosis (CRT); secondary outcome measures include toxicity, incidence of all thromboses and overall survival. Findings: Compared to control, warfarin (79% FDW; 21% DAW) reduced neither CRT [5.9% vs 5.9%; relative risk (RR) 0.99, (95% Confidence Interval (CI) 0.57-1.72), p=0.98] nor all thrombotic events [7.4% vs 9.4%; RR 0.78 (95%CI 0.50-1.24), p=0.30]. However, compared to FDW only, DAW was superior in preventing CRT [2.8% vs 7.2%; RR 0.38, (95%CI 0.20-0.71), p=0.002] but not all thromboses [5.5% vs 7.9%; RR 0.70 (95%CI 0.43-1.14), p=0.15]. Major bleeding events were rare; an excess was observed with warfarin compared to control (7 vs 1, p=0.07) and with DAW compared to FDW (16 vs 7, p=0.09). A combined endpoint of thromboses and major bleeding showed no difference between warfarin and control or between DAW and FDW. No survival difference was demonstrated in either comparison. Interpretation: Thrombosis rates were low (5.3%); there is no benefit in using warfarin in comparison to no warfarin for the prophylaxis of symptomatic CRT or other thromboses in cancer patients.",
author = "AM Young and Lucinda Billingham and G Begum and DJ Kerr and Ana Hughes and Daniel Rea and S Shepherd and A Stanley and A Sweeney and J Wilde and Keith Wheatley",
year = "2009",
month = feb,
day = "14",
doi = "10.1016/S0140-6736(09)60205-1",
language = "English",
volume = "373",
pages = "567--74",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier",
number = "9663",

}

RIS

TY - JOUR

T1 - Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial.

AU - Young, AM

AU - Billingham, Lucinda

AU - Begum, G

AU - Kerr, DJ

AU - Hughes, Ana

AU - Rea, Daniel

AU - Shepherd, S

AU - Stanley, A

AU - Sweeney, A

AU - Wilde, J

AU - Wheatley, Keith

PY - 2009/2/14

Y1 - 2009/2/14

N2 - Background: The role and dose of anticoagulants in thrombosis prophylaxis for cancer patients with central venous catheters (CVCs) is controversial. Methods: 1590 cancer patients receiving chemotherapy via CVCs were randomised to no warfarin [control] vs warfarin [either daily fixed dose 1mg warfarin (FDW) or daily dose adjusted warfarin (DAW) to maintain International Normalised Ratio between 1.5 and 2.0]. Clinicians ‘certain’ of the benefit of warfarin randomised between FDW and DAW. The primary outcome measure is the incidence of radiologically proven, symptomatic catheter-related thrombosis (CRT); secondary outcome measures include toxicity, incidence of all thromboses and overall survival. Findings: Compared to control, warfarin (79% FDW; 21% DAW) reduced neither CRT [5.9% vs 5.9%; relative risk (RR) 0.99, (95% Confidence Interval (CI) 0.57-1.72), p=0.98] nor all thrombotic events [7.4% vs 9.4%; RR 0.78 (95%CI 0.50-1.24), p=0.30]. However, compared to FDW only, DAW was superior in preventing CRT [2.8% vs 7.2%; RR 0.38, (95%CI 0.20-0.71), p=0.002] but not all thromboses [5.5% vs 7.9%; RR 0.70 (95%CI 0.43-1.14), p=0.15]. Major bleeding events were rare; an excess was observed with warfarin compared to control (7 vs 1, p=0.07) and with DAW compared to FDW (16 vs 7, p=0.09). A combined endpoint of thromboses and major bleeding showed no difference between warfarin and control or between DAW and FDW. No survival difference was demonstrated in either comparison. Interpretation: Thrombosis rates were low (5.3%); there is no benefit in using warfarin in comparison to no warfarin for the prophylaxis of symptomatic CRT or other thromboses in cancer patients.

AB - Background: The role and dose of anticoagulants in thrombosis prophylaxis for cancer patients with central venous catheters (CVCs) is controversial. Methods: 1590 cancer patients receiving chemotherapy via CVCs were randomised to no warfarin [control] vs warfarin [either daily fixed dose 1mg warfarin (FDW) or daily dose adjusted warfarin (DAW) to maintain International Normalised Ratio between 1.5 and 2.0]. Clinicians ‘certain’ of the benefit of warfarin randomised between FDW and DAW. The primary outcome measure is the incidence of radiologically proven, symptomatic catheter-related thrombosis (CRT); secondary outcome measures include toxicity, incidence of all thromboses and overall survival. Findings: Compared to control, warfarin (79% FDW; 21% DAW) reduced neither CRT [5.9% vs 5.9%; relative risk (RR) 0.99, (95% Confidence Interval (CI) 0.57-1.72), p=0.98] nor all thrombotic events [7.4% vs 9.4%; RR 0.78 (95%CI 0.50-1.24), p=0.30]. However, compared to FDW only, DAW was superior in preventing CRT [2.8% vs 7.2%; RR 0.38, (95%CI 0.20-0.71), p=0.002] but not all thromboses [5.5% vs 7.9%; RR 0.70 (95%CI 0.43-1.14), p=0.15]. Major bleeding events were rare; an excess was observed with warfarin compared to control (7 vs 1, p=0.07) and with DAW compared to FDW (16 vs 7, p=0.09). A combined endpoint of thromboses and major bleeding showed no difference between warfarin and control or between DAW and FDW. No survival difference was demonstrated in either comparison. Interpretation: Thrombosis rates were low (5.3%); there is no benefit in using warfarin in comparison to no warfarin for the prophylaxis of symptomatic CRT or other thromboses in cancer patients.

U2 - 10.1016/S0140-6736(09)60205-1

DO - 10.1016/S0140-6736(09)60205-1

M3 - Article

C2 - 19217991

VL - 373

SP - 567

EP - 574

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9663

ER -