Key result
Warfarin linked to ~16% lower mortality vs. other anticoagulants in cancer-associated VTE.
Why the study?
While trials have established the safety and efficacy of DOACs and LMWH over warfarin in cancer-associated thrombosis, emerging evidence suggests warfarin may improve overall survival in malignancy.
Does warfarin improve overall survival compared to other anticoagulants in patients with cancer-associated venous thromboembolism?
Cohort (n=12,298)
Yes
Does warfarin improve overall survival compared to other anticoagulants in patients with cancer-associated venous thromboembolism?
Effect estimate: HR 0.84 (95% CI 0.80-0.88)
Absolute Event Rate: 1457% vs 1045%
p-value: p=<0.001
In patients with cancer-associated venous thromboembolism, warfarin use was associated with significantly improved overall survival compared to DOACs or LMWH, particularly when maintaining an INR of 2.5-3.0.
May support warfarin over DOACs/LMWH in cancer-associated VTE; leaves open causality pending randomized confirmation.[[1]](https://ashpublications.org/blood/article/142/Supplement%201/138/502551/Overall-Survival-of-Warfarin-Compared-to-LMWH)[[2]](https://pmc.ncbi.nlm.nih.
Venous thromboembolism (VTE) is a common complication among patients with cancer. While randomized clinical trials have established the safety and efficacy of direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) relative to warfarin for the treatment of cancer-associated thrombosis, emerging evidence suggests that warfarin may be associated with improved overall survival in patients with malignancy. To evaluate survival outcomes among patients with cancer and VTE treated with warfarin compared with other anticoagulants within the Veterans Affairs (VA) Health Care System and analyze the association of international normalized ratio (INR) exposure and overall survival. Among 12 298 propensity-matched patients (mean age 69 years; 97% men), warfarin use was associated with a 16% lower risk of mortality compared with other anticoagulants (hazard ratio [HR], 0.84; (95% CI, 0.80-0.88); P < .001). Median survival was 1457 days in the warfarin group vs 1045 days in the non-warfarin group. Survival benefits were consistent across subgroups defined by tumor type, stage, and demographic characteristics. In landmark analyses the greatest benefit was observed with extended periods in the INR range of 2.5 to 3.0 (HR, 0.81; 95% CI, 0.75-0.87). In this population-based cohort study of patients with cancer and VTE, warfarin use was associated with improved survival compared with other anticoagulants. The greatest benefit was observed among patients who maintained an INR between 2.5 and 3.0.
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Ryu et al. (2026) conducted a cohort in Cancer-associated venous thromboembolism (n=12,298). Warfarin vs. Other anticoagulants (DOAC, LMWH, or direct thrombin inhibitor) was evaluated on Overall survival (mortality) (HR 0.84, 95% CI 0.80-0.88, p=<0.001). Warfarin use was associated with a 16% lower risk of mortality compared with other anticoagulants in patients with cancer-associated venous thromboembolism (HR 0.84).
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