Choice of Anticoagulant for Acute and Long-Term (First 3 Months) Therapy AT9 recommendations on choice of anticoagulant therapy were based on comparisons of VKA with LMWH that were performed in the preceding two and with two of the NOACs (dabigatran,20 ) that had recently been published. Although we judged that there was no convincing evidence that the ef cacy of LMWH compared with VKA differed between VTE patients without and with cancer, there are, nevertheless, reasons to make different suggestions for the preferred anticoagulant in patients without and with cancer.1 We suggested VKA therapy over LMWH in patients without cancer for the following reasons: injections are burdensome; LMWH is expensive; there are low rates of recurrence with VKA in patients with VTE without cancer; and VKA may be as effective as LMWH in patients without cancer. We suggested LMWH over VKA in patients with cancer for the following reasons: there is moderate-quality evidence that LMWH was more effective than VKA in patients with cancer; there is a substantial rate of recurrent VTE in patients with VTE and cancer who are treated with VKA; it is often harder to keep patients with cancer who are on VKA in the therapeutic range; LMWH is reliable in patients who have dif culty with oral therapy (eg, vomiting); and LMWH is easier to withhold or adjust than VKA if invasive interventions are required or thrombocytopenia develops. One new randomized trial compared LMWH (tinzaparin) with warfarin for the rst 6 months of treatment in 900 cancer patients with VTE.22 The ndings of this study are consistent with evidence in AT9 that LMWH is more effective than VKA for long- term treatment of VTE, but that there is no difference in major bleeding or death (Table 1, e-Table 4). 