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). Consequently, we still suggest VKA over LMWH in patients without cancer, and LMWH over VKA in patients with cancer, and we have not changed our assessment of the quality of evidence for either of these recommendations (Table 1, e-Table 4). We suggested VKA therapy or LMWH over the NOACs in AT9 because only two randomized trials had compared a NOAC (dabigatran,20 ) with VKA therapy, and none had compared a NOAC with long-term LMWH. In addition, at that time, there was little experience using a NOAC for treatment of VTE and a scarcity of long-term follow-up data to support their ef cacy and safety. Since then, four new TABLE 1 ] Summary of Findings: LMWH vs VKA for Long-Term Treatment of VTEa Outcomes No. 