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Ever since research suggested that small, fixed doses of warfarin prevent thrombosis associated with central venous catheters (CVCs; Ann Intern Med 1990; 112:423), this approach has been popular among oncologists. However, subsequent studies failed to confirm such activity of warfarin or other anticoagulants, including low-molecular-weight heparins. To determine whether warfarin truly is an effective thromboprophylactic agent in this setting, U.K. investigators performed a multicenter, randomized trial involving 1590 cancer patients who were receiving chemotherapy through CVCs.
Patients were assigned to receive fixed-dose warfarin (1 mg daily), adjusted-dose warfarin (to achieve an international normalized ratio [INR] of 1.5–2.0), or no warf…