THE EFFICACY AND SAFETY OF ORAL ANTICOAGULATION IN PATIENTS WITH CANCER

Objectives: To compare the complication rate (bleeding and thrombosis) of oral anticoagulation in a cohort of patients with cancer to a coho rt without cancer. Design: Prospective cohort study. Setting: Outpatie nt anticoagulation clinic in a community hospital. Patients: Consecuti ve patients enrolled in an anticoagulation clinic: 44 with cancer, 64 without cancer. Interventions: Patients received prophylactic doses of Warfarin (target INR 2-3 in the majority of instances) and complicati on rates were assessed. Measurements: Major bleeding (strictly defined ), minor bleeding, recurrent thrombosis, proportion of time with thera peutic INR, frequency of clinic visits. Results: The rates of major bl eeding, minor bleeding, and recurrent thrombosis were not statisticall y significantly different in the two groups of patients. Therapeutic I NR's were more difficult to sustain in the cancer patients as compared to the non-cancer patients (43.3% vs 56.9%, p <0.0001). There was a n on significant trend towards more frequent monitoring for the cancer p atients compared with the noncancer patients (4.6 vs 3.5 visits per tr eatment month, p = 0.14). Conclusions: Oral anticoagulation is safe an d effective in the patient with cancel. It is more difficult to Sustai n a therapeutic INR in the cancer patients and they may need more freq uent monitoring to achieve a low complication rate.