Laurie Barclay, MD

NEW YORK (MedscapeWire) Mar 28 — In orthopaedic surgery, 4 weeks of prophylaxis with low molecular weight heparin is more effective than 1 week for the prevention of venous thromboembolism. Results of a trial published in the March 28 issue of the New England Journal of Medicine suggest that the same is true following abdominal or pelvic surgery for cancer.
"Enoxaparin prophylaxis for four weeks after surgery for abdominal or pelvic cancer is safe and significantly reduces the incidence of venographically demonstrated thrombosis, as compared with enoxaparin prophylaxis for one week," write David Bergqvist, MD, PhD, and colleagues in the Enoxaparin and Cancer (ENOXACAN II) study.

In this double-blind trial, 332 patients undergoing planned abdominal or pelvic cancer surgery all received 40 mg of enoxaparin subcutaneously daily for 6 to 10 days, and they were randomized to subsequent treatment with enoxaparin or placebo for another 21 days.

After treatment, 12.0% in the placebo group and 4.8% in the enoxaparin group had venous thromboembolism (P = .02). At 3 months, this difference persisted (13.8% vs 5.5%; P = .01). Three patients in the enoxaparin group and 6 patients in the placebo group died within 3 months, but hemorrhagic and other complications were similar in both groups.

Although the study did not specifically address cost-benefit analysis, "there is reason to believe that four weeks of prophylaxis may have economic benefits in high-risk cancer surgery," the authors write.

Aventis Pharmaceuticals helped support this study.

N Engl J Med. 2002;346(13):975-980

Reviewed by Gary D. Vogin, MD

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