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Enoxaparin once daily vs. twice daily dosing for the treatment of venous thromboembolism in cancer patients: A literature summary

Current anticoagulation guidelines for cancer patients are largely based upon studies done in the general population. Anticoagulation studies in cancer patients with venous thromboembolism (VTE) have compared varying doses of different low molecular weight heparins (LMWH) to warfarin or unfractionated heparin (UFH) regimens, and most guidelines recommend LMWH as the preferred agent over vitamin K antagonists. However, very few studies compare different dosing regimens of the LMWH itself. As a result, practitioners attempt to extrapolate results from studies done in the general medicine population and apply them to cancer patients with VTE. Considering the differences in risk factors and hypercoagulability between these populations, such generalizations may compromise outcomes or safety for cancer patients. Currently, no study to date has compared the safety and efficacy of enoxaparin 1.5 mg/kg subcutaneously (SC) once daily vs. 1 mg/kg SC twice daily in a prospective, randomized fashion, for the longterm treatment of VTE in patients with cancer. The purpose of this article is to review currently available literature utilizing these dosing schemes in order to risk-stratify cancer patients who may better qualify for one dosing regimen as compared to the other. Our analysis suggests that enoxaparin dosed at 1.5 mg/kg SC once daily may be a safe and effective alternative for the treatment of VTE in cancer patients with both a low risk of recurrent VTE and bleeding. In the absence of additional studies, the dosing of enoxaparin for cancer patients should be based on patient-specific risk factors.