Abali, Gulcan

Abali, Huseyin

Mualloglu, Sadik

Sezer, Ahmet

Sumbul, Ahmet Taner

Sumbul, Zehra

Asian Pacific Journal of Cancer Prevention

English

Ahmet Sezer

Ahmet Taner Sumbul

Gulcan Abali

Zehra Sumbul

Sadik Muallaoglu

Huseyin Abali

Crossref

Can Low Molecular Weight Heparins Circumvent the Problem of Coumadine and Chemotherapy Interaction in Cancer Patients with Prosthetic Heart Valves?

Muallaoglu, Sadik

Acibadem University Repository

Baskent Universtiy

Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 1889
DOI:http://dx.doi.org/10.7314/APJCP.2014.15.4.1889
Low MW Heparins for Cancer Patients with Prosthetic Heart Valves?
Asian Pac J Cancer Prev, 15 (4), 1889-1890
Dear Editor
 In the everyday routine practice of a medical 
oncologist, it is not so infrequent that a patient with 
prosthetic heart valve who is on warfarine therapy has to 
receive chemotherapy, . This is a problematic situation for 
a medical oncologist since, drug interactions of warfarine 
with various chemotherapeutics are unpredictable, 
the result may either be thrombosis or bleeding. 
Furthermore, chemotherapeutic agents are given mostly 
on an intermittent basis, meaning that these unpredictable 
interactions occur when chemotherapy is given and then 
thrombocytopenia follows. The data on how to continue 
anti-coagulation therapy in such patients are sparse and in 
major guidelines, it is not involved (Holbrook et al., 2012; 
Vahanian et al., 2012). 
 Low molecular weight heparins (LMWH) are superior 
to warfarine in patients with cancer in the prophylaxis of 
deep vein thrombosis, probably owing to lack of significant 
drug interactions with chemotherapeutic agents. There is 
also no need for INR (International normalized ratio) 
monitorization. They are also safe as bridging therapy 
in patients with prosthetic heart valves peri-operatively 
instead of warfarine (Holbrook et al., 2012; Vahanian et al., 
2012). 
 For the reasons above, we tend to follow such patients 
on chemotherapy with LMWH instead of warfarine. 
Here, we wanted to share our experience on nine patients 
with prosthetic heart valves treated with LMWH during 
chemotherapy (Table 1).
 During our follow up, we had not observed neither any 
thrombotic complications nor LMWH associated bleeding 
LETTER to the EDITOR
Can Low Molecular Weight Heparins Circumvent the Problem 
of Coumadine and Chemotherapy Interaction in Cancer 
Patients with Prosthetic Heart Valves?
and this outcome has encouraged us to use LMWH in 
patients with cancer and prosthetic heart valve.
 During the past ten years developments in cancer care 
is prosperous. This positive trend has caused increased 
progression free and overall survival. But despite of 
this developments still dealing with cancer is a quite 
a hard problem for patients and medical oncologist 
because of concomittant chronic diseases (Abali et al., 
2011). During the treatment period complications usually 
disappointpatients and doctors and coumadine usage 
associated bleeding is one of them. By this report we want 
to take an attention and also share our recommendation to 
this problem. We hope that by counducting big randomized 
trials on this issue is going to clear the questions on the 
minds and will help initiating new guidelines lighting the 
way for this uncommon problem. 
References
Abali H, Ata A, Ozdogan M, Turhal S, et al (2011). Frequency 
of comorbid illnesses in cancer patients in Turkey. J BUON, 
16, 557-60
Holbrook A, Schulman S, Witt DM, et al (2012). Evidence-
based management of anticoagulant therapy: anti thrombotic 
therapy and prevention of thrombosis, 9th ed: American 
College of Chest Physicians evidence-based clinical practice 
guidelines. Chest, 141, 152-84.
Vahanian A, Alfieri O, Andreotti F, et al (2012). Joint Task 
Force on the Management of Valvular Heart Disease of the 
European Society of Cardiology (ESC) and the European 
Association for Cardio-Thoracic Surgery (EACTS). 
Guidelines on the management of valvular heart disease 
(version 2012). . Eur Heart J, 33, 2451-96.
Table 1. Patients with Cancer and Prosthetic Heart valve Treated with LMWH
Patient Age  Sex Primary Diseasest Prosthetic LMWH** LMWH Complication Follow time
No    diagnosis age valve  dosage (IU)  (months)
1 71 F NHL* IV Aortic Enoxaparin 2x6000 None 4
2 47 M Lung cancer IV Mitral Enoxaparin 2x8000 None 4
3 74 F Rectal cancer III Mitral Enoxaparin 2x8000 None 5
4 79 M Lung cancer IV Aortic Enoxaparin 2x6000 None 4
5 63 M Lung cancer IV Mitral Enoxaparin 2x6000 None 9
6 44 M Mesothelioma IV Mitral Enoxaparin 2x4000 None 4
7 56 F Breast cancer IV Mitral Enoxaparin 2x6000 None 6
8 45 F Parathyroid cancer IV Aortic Enoxaparin 2x4000 None 2
9 60 F Rectal Cancer III Mitral Enoxaparin 2x6000 None 6
*NHL: Non-hodgkin’s lymphoma; ** LMWH: Low Molecular Weight Heparin
Ahmet Sezer et al
Asian Pacific Journal of Cancer Prevention, Vol 15, 20141890
Department of Medical Oncology, 1Baskent University School 
of Medicine, 2Mustaf Kemal University School of Medicine, 
3Acıbadem University School of Medicine, 4Hatay State Hospital, 
Cardiology Clinic, Turkey  *For correspondence: drtanersu@
yahoo.com
Ahmet Sezer1, Ahmet Taner Sumbul2*, 
Gulcan Abali3, Zehra Sumbul4, Sadik 
Muallaoglu1, Huseyin Abali1


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Can Low Molecular Weight Heparins Circumvent the Problem of Coumadine and Chemotherapy Interaction in Cancer Patients with Prosthetic Heart Valves?

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