Key result
VKAs linked to ~12% lower mortality vs non-VKA anticoagulants in cancer, driven by observational data.
Why the study?
Low-molecular-weight heparins and direct oral anticoagulants have replaced vitamin K antagonists for cancer-associated VTE, but clinical trials have not established a survival benefit over VKAs.
Does Vitamin K antagonists (VKA) reduce all-cause mortality compared to non-VKA anticoagulants in adult patients with solid or hematologic malignancies?
Meta-Analysis (n=70,025)
Yes
Does Vitamin K antagonists (VKA) reduce all-cause mortality compared to non-VKA anticoagulants in adult patients with solid or hematologic malignancies?
Odds Ratio: 0.88 (95% CI 0.82–0.94)
Absolute Event Rate: 2.4% vs 2.6%
While observational studies suggest VKA use may confer a survival advantage over non-VKA anticoagulants in cancer patients, this benefit is not confirmed in randomized controlled trials.
Observational VKA mortality benefit should not change non-VKA preference in cancer; leaves open whether RCTs were underpowered or confounded.
Background: Venous thromboembolism (VTE) is a frequent complication in malignancy. Low-molecular-weight heparins and direct oral anticoagulants have replaced vitamin K antagonists (VKAs) as the standard of care for cancer-associated VTE. Nonetheless, clinical trials have not established a survival benefit of these agents compared with VKA. Objectives: We conducted a systematic review and meta-analysis to compare survival in cancer patients receiving VKA vs other anticoagulants. Methods: We searched Embase, Web of Science, PubMed, ClinicalTrials.gov, and Cochrane from inception until April 10, 2025, focusing on the use of VKA and non-VKA in cancer patients. Primary outcome was mortality and secondary outcomes included thromboembolism and bleeding. Results: = 42%) demonstrated improved survival with VKA. Conclusion: The use of VKA was associated with lower mortality than non-VKA anticoagulation in patients with cancer in observational studies but not in randomized trials. The analysis was limited by high heterogeneity, which must be considered when interpreting results.
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Xirou et al. (2025) conducted a meta-analysis in Cancer-associated venous thromboembolism or atrial fibrillation (n=70,025). Vitamin K antagonists vs. Non-VKA (LMWH or DOACs) was evaluated on All-cause mortality (OR 0.88, 95% CI 0.82-0.94). Vitamin K antagonists were associated with lower mortality compared to non-VKA anticoagulants in cancer patients (OR 0.88), a benefit observed in observational studies but not in randomized trials.
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