Journal: Haematologica
This VA Health Care System cohort study evaluated survival in cancer patients with venous thromboembolism treated with warfarin versus other anticoagulants (primarily LMWH and DOACs).
Key points:
- Population: 12,298 propensity-matched patients with active malignancy and VTE; mean age 69 years; 97% male.
- Exposure: Warfarin compared with non-warfarin anticoagulants.
- Main outcome: Overall survival.
Findings:
- Mortality risk: Warfarin use was associated with a 16% reduction in mortality risk versus other anticoagulants (HR 0.84; 95% CI 0.80–0.88; P<0.001).
- Median survival:
- Warfarin group: 1457 days
- Non-warfarin group: 1045 days
- Consistency across subgroups: The survival advantage with warfarin was consistent across tumor types, disease stages, and demographic subgroups.
- INR analysis:
- The greatest survival benefit was seen among patients with extended time in an INR range of 2.5–3.0 (HR 0.81; 95% CI 0.75–0.87).
Clinical implication:
Within this largely male veteran population with cancer-associated VTE, warfarin—particularly when INR is well controlled in the 2.5–3.0 range—was associated with better overall survival than LMWH/DOACs, suggesting a potential survival signal beyond standard efficacy/safety considerations for thrombosis treatment.