Correspondence

Prophylaxis against Venous Thromboembolism after Surgery for Cancer

N Engl J Med 2002; 347:220July 18, 2002

Article

To the Editor:

With regard to the study by Bergqvist et al. (March 28 issue),1 since cancer is a risk factor for thromboembolism2,3 and postsurgical immobilization adds to the risk, was it ethical to conduct a double-blind trial comparing low-molecular-weight heparin with placebo in patients who had undergone surgery for cancer? The significant reduction of the risk in the trial by Bergqvist et al. shows that the placebo group was exposed to a high risk of thromboembolism. Should the postoperative period after any type of major surgery be the subject of a new trial comparing low-molecular-weight heparin with placebo, to determine the value of heparin prophylaxis for each specific type of surgery?

Sophie Moulias, M.D.
Jean-Pierre Bouchon, M.D.
Sylvie Meaume, M.D.
Hôpital Charles Foix, 94200 Ivry/Seine, France
sophie.moulias@cfx.ap-hop-paris.fr

3 References

1
Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002;346:975-980
Full Text | Web of Science | Medline

2
Falanga A. Mechanisms of hypercoagulation in malignancy and during chemotherapy. Haemostasis 1998;28:Suppl 3:50-60
Medline

3
Geerts WH, Heit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest 2001;119:Suppl:132S-175S
CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Bergqvist replies:

To the Editor: The letter from Moulias et al. is obviously based on a misunderstanding of our report, and we are grateful to have the opportunity to answer. Cancer carries a high risk of postoperative venous thromboembolism, and many studies show that the risk can be significantly decreased with heparin prophylaxis for about one week after surgery. Therefore, all our patients received prophylaxis during that period. Before our study, it was not known whether patients who undergo surgery for abdominal or pelvic cancer have a prolonged period of risk warranting extended heparin prophylaxis. Therefore, it was logical and also ethical to randomly assign patients to continued prophylaxis for another three weeks or to placebo.

David Bergqvist, M.D., Ph.D.
University Hospital, SE-751 85 Uppsala, Sweden
david.bergqvist@kirurgi.uu.se

for the ENOXACAN II Study Group

Citing Articles (1)