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Journal of Oncology
Volume 2015, Article ID 502089, 6 pages
Clinical Study

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

1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
2School of Health in Social Science, University of Edinburgh, 13/4 Lauriston Gardens, Edinburgh EH3 9HH, UK
3Department of Neurology, Maria Sungmo Hospital, Seoul 150-038, Republic of Korea

Received 25 November 2014; Accepted 22 April 2015

Academic Editor: Bruce C. Baguley

Copyright © 2015 Hyemin Jang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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, ). On multiple logistic regression analysis, use of warfarin (OR 12.95; ) and the presence of systemic metastasis (OR 18.73; ) 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.