Examining Differences in Weekly Warfarin Dose in Patients With and Without Cancer

Abstract

The incidence of thrombosis and bleeding is higher in patients with cancer receiving warfarin compared with low molecular weight heparins. Despite these findings, warfarin remains a commonly used treatment strategy for anticoagulation in patients with cancer secondary to several factors that limit the use of low molecular weight heparins. Determining the appropriate warfarin dose in cancer patients is challenging. The objective of our study is to compare the weekly warfarin dose in patients with and without cancer. In a retrospective analysis, the average weekly warfarin dose was compared for 63 subjects who 1) were treated for cancer while receiving warfarin (n = 21), 2) completed treatment for their cancer before starting warfarin (n = 21), and 3) received warfarin with no diagnosis of cancer (n = 21). The data were abstracted from the medical record from the date the subject started taking a stable dose of warfarin after the initial titration until the discontinuation of warfarin. No significant differences were observed in the mean weekly warfarin dose, but the dose demonstrated greater intrasubject variability for subjects in group 1 (group 1, 31 +/- 22% vs. 2, 19 +/- 11% and 3, 15 +/- 10%, P = 0.003). Subjects in group 1 also spent more time above their goal International Normalized Ratio (group 1, 30 +/- 21% vs. 2, 21 +/- 16% and 3, 15 +/- 16%, P = 0.038). The average weekly warfarin dose was similar for the three groups, but the results of this study suggest that patients with cancer receiving treatment for their cancer and anticoagulation with warfarin are more difficult to appropriately anticoagulate.