TY - JOUR
T1 - Overall survival with warfarin vs. low-molecular-weight heparin in cancer-associated thrombosis
AU - Chiasakul, Thita
AU - Redd, Robert
AU - Patell, Rushad
AU - Khan, Adeel M.
AU - McCarthy, Ellen P.
AU - Neuberg, Donna
AU - Zwicker, Jeffrey I.
N1 - Funding Information:
Dr. Zwicker has received research funding from Incyte and Quercegen; provided consultancy services to Sanofi, CSL, and Parexel; and received honoraria from/advisory board participation with Pfizer/Bristol Myers Squibb (BMS), Portola, and Daiichi. The remaining authors declare no competing financial interests.
Funding Information:
This work was supported by National Heart, Lung, and Blood Institute CLOT Consortium (U01HL143365) and Cancer Center Core Grant 5P30 CA006516. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Funding Information:
This work was supported by National Heart, Lung, and Blood Institute CLOT Consortium (U01HL143365) and Cancer Center Core Grant 5P30 CA006516. This study used the linked SEER‐Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER‐Medicare database. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U58DP003862‐01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER‐Medicare database.
Publisher Copyright:
© 2021 International Society on Thrombosis and Haemostasis.
PY - 2021/11
Y1 - 2021/11
N2 - 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.
AB - 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.
KW - anticoagulation
KW - cancer-associated thrombosis
KW - low-molecular-weight heparin
KW - venous thromboembolism
KW - warfarin
UR - http://www.scopus.com/inward/record.url?scp=85115202918&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115202918&partnerID=8YFLogxK
U2 - 10.1111/jth.15519
DO - 10.1111/jth.15519
M3 - Article
C2 - 34490999
AN - SCOPUS:85115202918
SN - 1538-7933
VL - 19
SP - 2825
EP - 2834
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 11
ER -