***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Lenalidomide plus dexamethasone is effective in the treatment of multiple myeloma ( MM ) but is associated with an increased risk of venous thromboembolism ( VTE ) . This prospect i ve , open-label , r and omized sub study of a phase 3 trial compared the efficacy and safety of thromboprophylaxis with low-dose aspirin ( ASA ) or low-molecular-weight heparin ( LMWH ) in patients with newly diagnosed MM , treated with lenalidomide and low-dose dexamethasone induction and melphalan-prednisone-lenalidomide consolidation . Overall , 342 patients who did not have clinical indications or contraindications to antiplatelet or anticoagulant therapy were r and omly assigned to receive ASA 100 mg/d ( n = 176 ) or LMWH enoxaparin 40 mg/d ( n = 166 ) . The incidence of VTE was 2.27 % in the ASA group and 1.20 % in the LMWH group . Compared with LMWH , the absolute difference in the proportion of VTE was 1.07 % ( 95 % confidence interval , -1.69 - 3.83 ; P = .452 ) in the ASA group . Pulmonary embolism was observed in 1.70 % of patients in the ASA group and none in the LMWH group . No arterial thrombosis , acute cardiovascular events , or sudden deaths were reported . No major hemorrhagic complications were reported . In previously untreated patients with MM receiving lenalidomide with a low thromboembolic risk , ASA could be an effective and less-expensive alternative to LMWH thromboprophylaxis BACKGROUND Use of low-molecular-weight heparins is avoided in patients with renal insufficiency because of concerns about an excessive anticoagulant effect and increased bleeding risk . To challenge this premise , we evaluated if deep vein thrombosis ( DVT ) prophylaxis with dalteparin sodium confers an excessive anticoagulant effect in critically ill patients with severe renal insufficiency . METHODS We conducted a multicenter , single-arm clinical trial of DVT prophylaxis with dalteparin sodium , 5000 IU once daily in critically ill patients with a creatinine clearance lower than 30 mL/min ( to convert to milliliters per second , multiply by 0.0167 ) . Bioaccumulation was defined by a trough anti-Xa level higher than 0.40 IU/mL , measured twice weekly . The pharmacodynamic properties of dalteparin were assessed by serial anti-Xa levels measured on days 3 , 10 , and 17 . RESULTS We enrolled 156 patients with a mean ( SD ) creatinine clearance of 18.9 ( 6.5 ) mL/min ; 18 were excluded because they died or were discharged before testing ( n = 3 ) or had prevalent DVT ( n = 15 ) . Of 138 patients included , the median ( interquartile range [ IQR ] ) duration of dalteparin exposure was 7 ( 4 - 12 ) days . In 120 patients who had at least 1 trough anti-Xa level ( 427 total measurements ) , no patient had bioaccumulation ( 0 % ; 95 % confidence interval [ CI ] : 0%-3.0 % ) ; the median ( IQR ) trough anti-Xa level was undetectable ( < 0.10 IU/mL [ < 0.10 to < 0.10 IU/mL ] ) . Based on serial measurements , peak anti-Xa levels were 0.29 to 0.34 IU/mL and trough levels were lower than 0.06 IU/mL. Deep vein thrombosis occurred in 7 of 138 patients ( 5.1 % ; 95 % CI , 2.5%-10.1 % ) ; major bleeding occurred in 10 patients ( 7.2 % ; 95 % CI , 4.0%-12.8 % ) , all with trough anti-Xa levels of 0.18 IU/mL or lower . CONCLUSION In critically ill patients with severe renal insufficiency , DVT prophylaxis with dalteparin sodium , 5000 IU once daily , is not associated with an excessive anticoagulant effect due to drug bioaccumulation and is unlikely to contribute to bleeding . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00138099 Background Advanced pancreatic cancer , in addition to its high mortality , is characterized by one of the highest rates of venous thromboembolic events ( VTE ) as compared to other types of cancer . Enoxaparin , a low molecular weight heparin ( LMWH ) , has proven to be effective for the prevention and treatment of VTE in surgical and general medical patients . Results of some small studies suggest that this benefit might extend to patients with cancer , however , enoxaparin is not currently indicated for this use . This phase IIb study was design ed to analyze the efficacy of enoxaparin in patients with locally advanced or metastatic pancreatic cancer undergoing systemic chemotherapy . Methods The aim of this prospect i ve multicenter trial is to compare concomitant treatment with enoxaparin to no anticoagulation  in 540 patients . Primary endpoint is the incidence of clinical ly relevant VTE ( symptomatic deep venous thrombosis ( DVT ) of the leg and /or pelvic and /or pulmonary embolism ( PE ) ) within the first 3 months . Secondary endpoints include the incidence of symptomatic and asymptomatic VTE after 6 , 9 and 12 months as well as remission at 3 , 6 , 9 and 12 months , overall survival and bleeding . Trial registration : is rct n.org identifier CCT-NAPN-16752 , controlled-trials.com identifier : IS RCT N02140505 . Results An interim analysis for safety performed after inclusion of 152 patients revealed no increased risk of bleeding ( 5 pts vs. 6 pts , Chi2 : 0.763 ) . Conclusion PROSPECT is a pivotal study in elucidating the role of low molecular weight heparins in advanced pancreatic cancer . Its results will lead to a new underst and ing of the role of heparins in the prevention of venous thromboembolism and of their effect on survival , remission rates and toxicity of chemotherapeutic regimens AIM To compare clinical outcomes in a r and omised comparison of treatment with danaparoid sodium ( a heparinoid ) , or dextran 70 , for heparin-induced thrombocytopaenia ( HIT ) plus thrombosis . METHODS Forty-two patients with recent thrombosis and a clinical diagnosis of probable HIT who presented at ten Australian hospitals during a study period of six and one half years were r and omly assigned to open-label treatment with intravenous danaparoid or dextran 70 , each combined with oral warfarin .  Thirty-four patients ( 83 % ) had a positive platelet aggregation or 14C-serotonin release test for HIT antibody . Twenty-five received danaparoid as a bolus injection of 2400 anti-Xa units followed by 400 units per hour for 2 h , 300 units per hour for 2 h , and then 200 units per hour for five days . Seventeen received 1000 mL dextran 70 on day one and then 500 mL on days 2 - 5 . Patients were review ed daily for clinical evidence of thrombus progression or resolution , fresh thrombosis or embolism , bleeding or other complications . The primary trial endpoint was the proportion of thromboembolic events with complete clinical resolution by the time of discharge from hospital . RESULTS With danaparoid , there was complete clinical recovery from 56 % of thromboembolic events compared to 14 % after dextran 70 ( Odds Ratio 10.53 , 95 % Confidence Interval 1.6 - 71.4 ; p = 0.02 ) . Clinical recovery with danaparoid was complete or partial in 86 % of thromboembolic events compared with 53 % after dextran 70 ( Odds Ratio 4.55 , 95 % Confidence Interval 1.2 - 16.7 ; p = 0.03 ) . Overall clinical effectiveness of danaparoid was rated as high or moderate in 88 % of patients compared with 47 % for dextran 70 ( p = 0.01 ) . One patient given danaparoid  died of thrombosis compared with three patients given dextran 70 . The platelet count returned to normal after a mean of 6.7 days with danaparoid and 7.3 days with dextran 70 . There was no major bleeding with either treatment . CONCLUSION danaparoid plus warfarin treatment for HIT with thrombosis is effective , safe , and superior to dextran 70 plus warfarin BACKGROUND Extended- duration low-molecular-weight heparin has been shown to prevent venous thromboembolism ( VTE ) in high-risk surgical patients . OBJECTIVE To evaluate the efficacy and safety of extended- duration enoxaparin thromboprophylaxis in acutely ill medical patients . DESIGN R and omized , parallel , placebo-controlled trial . R and omization was computer-generated . Allocation was central ized . Patients , caregivers , and outcome assessors were blinded to group assignment . ( Clinical Trials.gov registration number : NCT00077753 ) SETTING : 370 sites in 20 countries across North and South America , Europe , and Asia . PATIENTS Acutely ill medical patients 40 years or older with recently reduced mobility ( bed rest or sedentary without [ level 1 ] or with [ level 2 ] bathroom privileges ) . Eligibility criteria for patients with level 2 immobility were amended to include only those who had additional VTE risk factors ( age > 75 years , history of VTE , or active or previous cancer ) after interim analyses suggested lower-than-expected VTE rates . INTERVENTION Enoxaparin , 40 mg/d subcutaneously ( 2975 patients ) , or placebo ( 2988 patients ) , for 28 + /- 4 days after receiving open-label enoxaparin for an initial 10 + /- 4 days . MEASUREMENTS Incidence of VTE up to day 28 and of major bleeding events up to 48 hours after the last study treatment dose . RESULTS Extended- duration enoxaparin reduced VTE incidence compared with placebo ( 2.5 % vs. 4 % ; absolute risk difference favoring enoxaparin , -1.53 % [ 95.8 % CI , -2.54 % to -0.52 % ] ) . Enoxaparin increased major bleeding events ( 0.8 % vs. 0.3 % ; absolute risk difference favoring placebo , 0.51 % [ 95 % CI , 0.12 % to 0.89 % ] ) . The benefits of extended- duration enoxaparin seemed to be restricted to women , patients older than 75 years , and those with level 1 immobility . LIMITATION Estimates of efficacy and safety for the overall trial population are difficult to interpret because of the change in eligibility criteria during the trial . CONCLUSION Use of extended- duration enoxaparin reduces VTE more than it increases major bleeding events in acutely ill medical patients with level 1 immobility , those older than 75 years , and women . PRIMARY FUNDING SOURCE Sanofi-aventis PURPOSE A substantial clinical need exists for an alternative to vitamin K antagonists for treating deep-vein thrombosis in cancer patients who are at high risk of both recurrent venous thromboembolism and bleeding .  Low-molecular-weight heparin , body-weight adjusted , avoids anticoagulant monitoring and has been shown to be more effective than vitamin-K-antagonist therapy . SUBJECTS AND METHODS Subjects were patients with cancer and acute symptomatic proximal-vein thrombosis . We performed a multi-centre r and omized , open-label clinical trial using objective outcome measures comparing long-term therapeutic tinzaparin subcutaneously once daily with usual-care long-term vitamin-K-antagonist therapy for 3 months . Outcomes were assessed at 3 and 12 months . RESULTS Of 200 patients , 100 received tinzaparin and 100 received usual care . At 12 months , the usual-care group had an excess of recurrent venous thromboembolism ; 16 of 100 ( 16 % ) versus 7 of 100 ( 7 % ) receiving low-molecular-weight heparin ( P=.044 ; risk ratio=.44 ; absolute difference -9.0 ; 95 % confidence interval [ CI ] , -21.7 to -0.7 ) . Bleeding , largely minor , occurred in 27 patients ( 27 % ) receiving tinzaparin and 24 patients ( 24 % ) receiving usual care ( absolute difference -3.0 ; 95 % CI , -9.1 to 15.1 ) . In patients without additional risk factors for bleeding at the time of r and omization , major bleeding occurred in 0 of 51 patients ( 0 % ) receiving tinzaparin and 1 of 48 patients ( 2.1 % ) receiving usual care . Mortality at 1 year was high , reflecting the severity of the cancers ; 47 % in each group died . CONCLUSION Our findings confirm the limited but benchmark data in the literature that long- 
    Output:
    
In patients with solid tumours , lmwh is recommended for those with established vte and for those without established vte but with a high risk for developing vte .
No one agent can be recommended over another , but in the setting of renal insufficiency , tinzaparin is preferred .