Overall survival with warfarin versus low-molecular-weight heparin in cancer-associated thrombosis

Details

• Alternative Title:
  J Thromb Haemost
• Personal Author:
  Chiasakul, Thita ; Redd, Robert ; Patell, Rushad ; Khan, Adeel M ; McCarthy, Ellen P ; Neuberg, Donna ; Zwicker, Jeffrey I
• Description:
  Background:
  
  When compared with warfarin, low-molecular-weight heparin (LMWH) reduces the incidence of recurrent venous thromboembolism (VTE) in cancer. However, a survival benefit of LMWH over warfarin for the treatment of cancer-associated VTE has not been established.
  
  Methods:
  
  Using the Surveillance, Epidemiology and End Results (SEER) and Medicare linked database from 2007 through 2016, we identified Medicare beneficiaries (aged ≥66 years) who were: (1) diagnosed with primary gastric, colorectal, pancreatic, lung, ovarian, or brain cancer; (2) diagnosed with cancer-associated VTE; and (3) prescribed LMWH or warfarin within 30 days. The primary outcome was overall survival (OS). Patients were matched 1:1 using exact matching for cancer stage and propensity scored matching for cancer diagnosis, age, year of VTE, and time from cancer diagnosis to index VTE. Cox proportional-hazards regression was performed to estimate hazard ratios (HR) and 95% confidence intervals (95% CI).
  
  Results:
  
  A total of 9,706 patients were included. Warfarin was associated with a significant improvement in OS compared to LMWH (median OS, 9.8 months [95%CI, 9.1 to 10.4] versus 7.2 months [95%CI, 6.8 to 7.8]; HR, 0.86; 95% CI 0.83 to 0.90; P<0.001). The survival advantage was most pronounced in pancreatic (HR 0.82 [95% CI, 0.74 to 0.90], P<0.001) and gastric cancers (HR 0.82 [95% CI, 0.68 to 0.98], P=0.03). The observed differences in survival were consistent across subgroups including cancer stage, age, comorbidity burden, and year of VTE.
  
  Conclusions:
  
  In this population-based study, warfarin was associated with improved OS compared to LMWH for the treatment of cancer-associated VTE.
  
  
• Subjects:
  Aged Anticoagulants Heparin Heparin, Low-Molecular-Weight Humans Medicare Neoplasms Thrombosis United States Venous Thromboembolism Warfarin

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• Keywords:
  Alzheimer's Disease Alzheimer's Disease Sequencing Project Anticoagulation Antiviral Agents Cancer-associated Thrombosis Herpes Simplex Human Papillomavirus Low-molecular-weight Heparin Torque Teno Viruses Venous Thromboembolism Warfarin Whole Exome Sequencing Whole Genome Sequencing

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• Source:
  J Thromb Haemost. 19(11):2825-2834
• Pubmed ID:
  34490999
• Pubmed Central ID:
  PMC8530982
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; U01 HL143365/HL/NHLBI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; P30 CA006516/CA/NCI NIH HHSUnited States/ ; T32 HL007917/HL/NHLBI NIH HHSUnited States/
• Volume:
  19
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:dc51cb5570a46c194d5c27cc34cbc3ac77ceaa29f9021e0fbf66c85a564774662d57d030a3932d78664ac29536e38ecff5697e82c4bc5742b7c6896bdde54f9c
• Download URL:
  https://stacks.cdc.gov/view/cdc/111029/cdc_111029_DS1.pdf
• File Type:
  [PDF - 1.61 MB ]