Drug safety · 2026
Risk of Cancer Comparing Warfarin and Direct Oral Anticoagulants: Population-Based Cohort Studies in England and Hong Kong.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Wang Zixuan, Yu Qiuyan, Matthewman Julian, Tazare John, Majano Sara Benitez, Brown Jeremy, Cheung Ka Shing, Chui Celine S L, Chan Esther W Y, Bhaskaran Krishnan, Wong Ian C K, Douglas Ian J, Wong Angel Y S
Аннотация
BACKGROUND: Previous evidence suggests a potential protective effect of warfarin against cancer, compared to non-users. However, it may be prone to immortal time bias and residual confounding.
OBJECTIVE: We aimed to examine the association between cancer and warfarin, compared with active comparator (direct oral anticoagulants).
METHODS: We conducted studies using population-based databases from England and Hong Kong to investigate the association between warfarin and hazard of cancer using a new-user active-comparator cohort design. People with atrial fibrillation aged ≥ 18 years who had first received anticoagulant treatment during 01/01/2011-31/12/2019 were involved.
RESULTS: No evidence supported the association between warfarin and hazard of overall cancer, compared with direct oral anticoagulants in both settings (England: hazard ratio [HR] = 1.03, 95% confidence interval [CI] 0.94-1.13; Hong Kong: HR = 0.89, 95% CI 0.79-1.01). A lower hazard of female breast (HR = 0.49, 95% CI 0.30-0.79), ovarian (HR = 0.07, 95% CI 0.01-0.58), and pancreatic (HR = 0.46, 95% CI 0.22-0.96) cancers and a higher hazard of kidney cancer (HR = 3.57, 95% CI 1.64-7.76) were found in Hong Kong, comparing warfarin with direct oral anticoagulants, but these were not replicated in England.
CONCLUSIONS: This study does not find a protective effect of warfarin against cancer versus direct oral anticoagulants. The risks of site-specific cancers including pancreatic, kidney, and sex-specific cancers between oral anticoagulants shown in the Hong Kong setting only may require further investigation in other independent datasets.
OBJECTIVE: We aimed to examine the association between cancer and warfarin, compared with active comparator (direct oral anticoagulants).
METHODS: We conducted studies using population-based databases from England and Hong Kong to investigate the association between warfarin and hazard of cancer using a new-user active-comparator cohort design. People with atrial fibrillation aged ≥ 18 years who had first received anticoagulant treatment during 01/01/2011-31/12/2019 were involved.
RESULTS: No evidence supported the association between warfarin and hazard of overall cancer, compared with direct oral anticoagulants in both settings (England: hazard ratio [HR] = 1.03, 95% confidence interval [CI] 0.94-1.13; Hong Kong: HR = 0.89, 95% CI 0.79-1.01). A lower hazard of female breast (HR = 0.49, 95% CI 0.30-0.79), ovarian (HR = 0.07, 95% CI 0.01-0.58), and pancreatic (HR = 0.46, 95% CI 0.22-0.96) cancers and a higher hazard of kidney cancer (HR = 3.57, 95% CI 1.64-7.76) were found in Hong Kong, comparing warfarin with direct oral anticoagulants, but these were not replicated in England.
CONCLUSIONS: This study does not find a protective effect of warfarin against cancer versus direct oral anticoagulants. The risks of site-specific cancers including pancreatic, kidney, and sex-specific cancers between oral anticoagulants shown in the Hong Kong setting only may require further investigation in other independent datasets.