***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 Summary : A r and omized controlled trial was undertaken comparing the efficacy and safety of low molecular weight ( LMW ) heparin ( Fragmin ) with sodium heparin for prophylaxis against postoperative thromboembolic disease after major gynaecological surgery . Women were r and omized to receive subcutaneous injections of 5,000 U of either once daily LMW heparin or twice daily sodium heparin . A total of 566 women were recruited , of whom 552 completed the study . Most women ( 461 ) had malignant disease and 430 of these underwent radical surgery . The remainder underwent major , but not radical surgery . There were 5 thromboembolic events in the LMW heparin group and 2 in the sodium heparin group , with no significant difference between these groups . No significant difference was found in the incidence of intraoperative or postoperative transfusion in the 2 groups . The decision of which heparin to use in routine practice can not be made on clinical grounds PURPOSE Initial heparinization followed by vitamin K antagonists is the treatment of choice for patients with venous thromboembolism . There is controversy whether known malignancy is a risk factor for recurrences and bleeding complications during this treatment . Furthermore , the incidence of such events in these patients is dependent on the achieved International Normalized Ratio ( INR ) . The aim of this study was to assess the incidence of venous thromboembolic recurrence and major bleeding among patients with venous thromboembolism in relation to both malignancy and the achieved INR . PATIENTS AND METHODS In a retrospective analysis , the INR-specific incidence of venous thromboembolic and major bleeding events during oral anticoagulant therapy was calculated separately for patients with and without malignancy . Eligible patients participated in two multicenter , r and omized clinical trials on the initial treatment of venous thromboembolism . Patients were initially treated with heparin ( st and ard or low-molecular weight ) . Treatment with vitamin K antagonists was started within 1 day and continued for 3 months , with a target INR of 2.0 to 3.0 . RESULTS In 1,303 eligible patients ( 264 with malignancy ) , 35  recurrences  and 12  bleeds occurred . Patients with malignancy , compared with nonmalignant patients , had a clinical ly and statistically significantly increased overall incidence of recurrence ( 27.1 v 9.0 , respectively , per 100 patient-years ) as well as bleeding ( 13.3 v 2.1 , respectively , per 100 patient-years ) . In both groups of patients , the incidence of recurrence was lower when the INR was above 2.0 compared with below 2.0 . CONCLUSION Although adequately dosed vitamin K antagonists are effective in patients with malignant disease , the incidence of thrombotic and bleeding complications remains higher than in patients without malignancy Background Advanced pancreatic cancer ( APC ) , beside its high mortality , causes the highest rates of venous thromboembolic events ( VTE ) . Enoxaparin , a low molecular weight heparin ( LMWH ) , is effective in prevention and treatment of VTE . Some small studies indicated that this benefit might extend to patients with cancer and probably prolong survival due to independent mechanisms . We initiated this safety investigation to get feasibility information on intensified chemotherapy combined with LMWH in out patients with APC treated in 1st line . Methods The trial was a prospect i ve , open-label , single center investigation in out patients with inoperable pancreatic cancer who were treated with intensified first-line chemotherapy along with concomitant application of subcutaneous LMWH .  The combined chemotherapy consisted of gemcitabine 1 g/m2 ( 30 min ) , 5-FU 750 mg/m2 ( 24 h ) , folinic acid 200 mg/m2 ( 30 min ) , and Cisplatin 30 mg/m2 ( 90 min ) on day 1 and 8 ; q3w for the first 12 weeks ( GFFC ) followed by gemcitabine alone in patients without cancer progression . The simultaneous application of prophylactic enoxaparin started on day 1 of chemotherapy with a fixed dose of 40 mg daily . Statistical analyses were performed using R 3.01 with software package CMPRSK and SPSS software v19.0 . Results The investigation was stopped after recruitment of 19 patients . At this time 15 patients had completed the required 12 weeks of treatment . Based on 71 cycles of GFFC + enoxaparin ( median 4/pt [ range : 2–4 ] ) and 108 cycles of single-agent gemcitabine + enoxaparin ( median 4/pt [ range : 0–18 ] ) the cumulative frequency of NCI-CTC toxicities grade 3/4 was below 10 % . One case ( 5 % ) of a symptomatic non-lethal thromboembolic event was observed while receiving LMWH treatment . No severe bleeding event as defined in the protocol has been observed . The median overall survival was 10.05 [ 95 % CI : 8.67 - 18.14 ] months . Conclusions The addition of enoxaparin to GFFC chemotherapy is feasible , safe and does not appear to affect the efficacy or the toxicity profile of the chemotherapy regimen in patients with advanced pancreatic adenocarcinoma . Based on these findings we have initiated the r and omized CONKO-004 trial to examine whether enoxaparin reduces the incidence of thromboembolic events or increases overall outcome .Trial registration Clinical Trials NCT01945879 BACKGROUND Patients with acute proximal deep-vein thrombosis are usually treated first in the hospital with intravenous st and ard ( unfractionated ) heparin . However , the longer plasma half-life , better bioavailability after subcutaneous administration , and more predictable anticoagulant response of low-molecular-weight heparins make them attractive for possible home use . We compared these two approaches . METHODS Patients with acute proximal deep-vein thrombosis were r and omly assigned to receive either intravenous st and ard heparin in the hospital ( 253 patients ) or low-molecular-weight heparin ( 1 mg of enoxaparin per kilogram of body weight subcutaneously twice daily ) administered primarily at home ( 247 patients ) . The study design allowed out patients taking low-molecular-weight heparin  to go home immediately and hospitalized patients taking low-molecular-weight heparin to be discharged early . All the patients received warfarin starting on the second day . RESULTS Thirteen of the 247 patients receiving low-molecular-weight heparin  ( 5.3 percent ) had recurrent thromboembolism , as compared with 17 of the 253 patients receiving st and ard heparin ( 6.7 percent ; P=0.57 ; absolute difference , 1.4 percentage points ; 95 percent confidence interval , -3.0 to 5.7 ) . Five patients receiving low-molecular-weight heparin had major bleeding , as compared with three patients receiving st and ard heparin . After r and omization , the patients who received low-molecular-weight heparin spent a mean of 1.1 days in the hospital , as compared with 6.5 days for the st and ard-heparin group ; 120 patients in the low-molecular-weight- heparin group did not need to be hospitalized at all . CONCLUSIONS Low-molecular-weight heparin can be used safely and effectively to treat patients with proximal deep-vein thrombosis at home 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 Subcutaneous body weight-adjusted low molecular weight heparin ( LMWH ) has been proven as effective and safe as intravenous aPTT-adjusted unfractionated heparin ( UFH ) for the treatment of patients with acute deep venous thrombosis ( DVT ) . In this study we evaluate the efficacy of the initial treatment of proximal DVT with a fixed-dose , body weight-independent application of the LMWH Certoparin with a six month follow-up . In a prospect i ve , multicentre , r and omized , active-controlled study 1220 patients with objective ly diagnosed proximal DVT were r and omly assigned to subcutaneous 8000 U anti-factor Xa of Certoparin twice daily for 10 to 14 days or intravenous aPTT-adjusted UFH for 5 to 8 days . Both regimen were followed by oral anticoagulation for 6 months . The primary end point was the rate of symptomatic and objective ly confirmed thromboembolic events within 6 months . The aim of the study was to demonstrate the non-inferiority of the Certoparin regimen as compared to UFH . The per- protocol analysis revealed 22 ( 3.8 % ) thromboembolic events in the Certoparin group and 24 ( 4.3 % ) in patients assigned to UFH within 6 months , thereby proving the non-inferiority ( p<0.01 ) , confirmed by intent-to-treat analysis ( p<0.001 ) . Major bleeding occurred in 6 and 7 patients started on Certoparin or UFH during the treatment period . Thromboembolic events were equally distributed in body weight categories with < 50 , 50 - 80 and > 80 kg as followed : 0 , 3.6 % and 4.1 % of patients for the Certoparin group and 0 , 4.6 % and 4.2 % of patients for the UFH group . The same was true for major bleeding complications with 0 , 2.9 % and 1.5 % for Certoparin and 0 , 3.5 % and 4.2 % for UFH .  Overall mortality was 1.9 % in the Certoparin group and 2.7 % in the UFH group . Fixed-dose body weight-independent subcutaneous LMWH Certoparin is at least as efficacious and safe as intravenous aPTT-adjusted UFH for the 
    Output:
    
LMWH is possibly superior to UFH in the initial treatment of VTE in people with cancer .