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

Thita Chiasakul, Robert Redd, Rushad Patell, Adeel M. Khan, Ellen P. McCarthy, Donna Neuberg, Jeffrey I. Zwicker

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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 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 score 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 9706 patients were included. Warfarin was associated with a significant improvement in OS compared with LMWH (median OS, 9.8 months [95% CI, 9.1–10.4] vs. 7.2 months [95% CI, 6.8–7.8]; HR, 0.86; 95% CI 0.83–0.90; p <.001). The survival advantage was most pronounced in pancreatic (HR 0.82 [95% CI, 0.74–0.90], p <.001) and gastric cancers (HR 0.82 [95% CI, 0.68–0.98], p =.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 with LMWH for the treatment of cancer-associated VTE.

Original languageEnglish (US)
Pages (from-to)2825-2834
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Issue number11
StatePublished - Nov 2021
Externally publishedYes


  • anticoagulation
  • cancer-associated thrombosis
  • low-molecular-weight heparin
  • venous thromboembolism
  • warfarin

ASJC Scopus subject areas

  • Hematology


Dive into the research topics of 'Overall survival with warfarin vs. low-molecular-weight heparin in cancer-associated thrombosis'. Together they form a unique fingerprint.

Cite this