Comparison of Enoxaparin and Warfarin for Secondary Prevention of Cancer-Associated Stroke

Background. the aim of this study was to determine which anticoagulant is superior for secondary prevention of cancer-associated stroke,using changes in d-dimer levels as a biomarker for recurrent thromboembolic events. methods. we conducted a retrospective,single center observational study including patients with cancer-associated stroke who were treated with either enoxaparin or warfarin. blood samples for measuring the initial and follow-up d-dimer levels were collected at admission and a median of 8 days after admission,respectively. multiple logistic regression analysis was conducted to evaluate the factors that influenced d-dimer levels after treatment. results. although the initial d-dimer levels did not differ between the two groups,the follow-up levels were dramatically decreased in patients treated with enoxaparin,while they did not change with use of warfarin (3.88 μg/ml versus 17.42 μg/ml,p = 0.026). on multiple logistic regression analysis,use of warfarin (or 12.95; p = 0.001) and the presence of systemic metastasis (or 18.73; p = 0.017) were independently associated with elevated d-dimer levels (≥10 μg/ml) after treatment. conclusion. in cancer-associated stroke patients,treatment with enoxaparin may be more effective than treatment with warfarin for lowering the d-dimer levels. future prospective studies are warranted to show that enoxaparin is better than warfarin for secondary prevention in cancer-associated stroke. copyright © 2015 hyemin jang et al.