The impact of warfarin on overall survival in cancer patients.

Venous thromboembolism (VTE) is a common complication in patients with cancer. Warfarin has largely been replaced by low-molecular-weight heparin (LMWHs) and direct oral anticoagulants (DOACs) as the standard of care in cancer-associated VTE. The survival benefit of these anticoagulants over warfarin in the cancer population has not been demonstrated in clinical trials. There are emerging population-based studies suggesting that warfarin may be associated with improved overall survival in cancers. Warfarin has anti-neoplastic activity mediated through both coagulation pathway -dependent and -independent mechanisms, the latter of which includes inhibition of the Gas6-AXL signaling pathway. Further research is warranted to understand the clinical and laboratory predictors of survival benefit with warfarin. In this review article, we summarize and update the current evidence regarding the potential impact of warfarin on the overall survival of cancer patients and incidence of cancer, as well as review the potential mechanism of such effect and future perspectives. • Emerging population-based evidence suggests an association of warfarin with improved overall survival in cancer patients. • Anti-neoplastic mechanisms of warfarin include inhibition of thrombin and Gas6 signaling. • Implications for future research include identifying subgroups with improved outcomes. [ABSTRACT FROM AUTHOR]