Division of Hematology and Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Thromb Res. 2022 May;213(Suppl 1):S113-S119. doi: 10.1016/j.thromres.2021.11.004. Epub 2021 Nov 14.
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 Warfarin has largely been replaced by low-molecular-weight heparin (LMWHs) and direct oral anticoagulants (DOACs) as the standard of care in cancer-associated VTE.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 was not demonstrated in clinical trials, possibly due to insufficient sample size and limited follow-up duration. There are emerging population-based studies suggesting that warfarin may be associated with improved overall survival in cancers and may have a protective effect against certain types of cancers. Warfarin may exert its anti-neoplastic properties through both coagulation pathway -dependent and -independent mechanisms, the latter of which are mediated by inhibition of the Gas6-AXL signaling pathway. Further research should emphasize on identifying clinical and laboratory predictors of beneficial effects of 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.
静脉血栓栓塞症（VTE）是癌症患者的常见并发症。华法林在癌症相关 VTE 的治疗中已被低分子量肝素（LMWH）和直接口服抗凝剂（DOAC）取代。这些抗凝剂在癌症患者中的生存获益并未在临床试验中得到证实，这可能是由于样本量不足和随访时间有限。目前有一些基于人群的新兴研究表明，华法林可能与癌症患者的总体生存率提高有关，并且可能对某些类型的癌症具有保护作用。华法林可能通过凝血途径依赖性和非依赖性机制发挥其抗肿瘤特性，后者是通过抑制 Gas6-AXL 信号通路介导的。进一步的研究应强调确定华法林有益作用的临床和实验室预测因子。在这篇综述文章中，我们总结和更新了目前关于华法林对癌症患者总体生存率和癌症发病率的潜在影响的证据，并回顾了这种影响的潜在机制和未来展望。
