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Thromboprophylaxis in cancer patients with central venous catheters

Young, Annie (2011)
Ph.D. thesis, University of Birmingham.

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This thesis focuses on a nurse-led trial assessing the thromboprophylactic utility of warfarin in cancer patients (n=1590) with central venous catheters and designed following a UK survey of practice.

Clinicians who were ‘uncertain’ of the benefits of warfarin, randomised patients to no warfarin vs fixed dose warfarin of 1mg (FDW) vs dose adjusted warfarin (DAW) to maintain the international normalised ratio (INR) between 1.5 and 2.0. Clinicians, who were ‘certain’, randomised patients between FDW and DAW. The primary endpoint was the number of symptomatic catheter-related thrombotic events (CRT).

Compared to no warfarin, warfarin (79% FDW; 21% DAW) did not reduce CRT [5.9% vs 5.9%; relative risk (RR) 0.99, (95% Confidence Interval (CI) 0.57-1.72), p=0.98]. However, compared to FDW, DAW was superior in preventing CRT [2.8% vs 7.2%; RR 0.38, (95%CI 0.20-0.71), p=0.002]. Major bleeding events were rare; an excess was observed with warfarin compared to no warfarin (7 vs 1, p=0.07) and with DAW compared to FDW (16 vs 7, p=0.09).

There is no benefit in using low dose warfarin in CRT prophylaxis. DAW shows benefit over FDW but at a cost of major bleeding events. Subsequent meta-analysis confirmed the primary finding. This research has changed clinical practice internationally.

Type of Work:Ph.D. thesis.
Supervisor(s):Clifford, Collette and Wheatley, Keith
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:School of Cancer Sciences
Additional Information:

Published papers from Appendix 9 are available at

Subjects:R Medicine (General)
RA0421 Public health. Hygiene. Preventive Medicine
RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Institution:University of Birmingham
ID Code:1721
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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