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.
Graham J. Caine, Gregory Y. H. Lip. Is Low-Molecular-Weight Heparin Safer Than Warfarin for Secondary Prevention of Venous Thromboembolism in Cancer Patients?. Arch Intern Med. 2003;163(10):1243–1244. doi:10.1001/archinte.163.10.1243-a