Threading the needle.

Venous thromboembolism (VTE) is relatively frequent among cancer patients. These patients once required warfarin for six months, with the upside that it was just a pill. This has been largely replaced by low molecular weight heparin such as lovenox, with the upside of better safety and far fewer interactions with diet and drugs. The only problem is, it turns out patients generally don’t enjoy subcutaneous injections every day for six months. Thankfully the Hokusai VTE trial published in NEJM last week finally gives us a safe answer packaged in a pill. TBL: The oral anticoagulant edoxaban (factor Xa inhibitor) was found to be noninferior to lovenox for reducing recurrent cancer-associated VTE or major bleeding.