Effect of Warfarin on Survival in Small Cell Carcinoma of the Lung

Zacharski, Leo R.; Henderson, William G.; Rickles, Frederick R.; Forman, Walter B.; Cornell, Cornelius J.; Forcier, R. Jackson; Edwards, R. Lawrence; Headley, Elwood; Kim, Sanghee; O'Donnell, Joseph; OʼDell, Robert; Tornyos, Karl; Kwaan, Hau C.

doi:10.1001/jama.1981.03310330021017

Cited by 161 publications

(55 citation statements)

References 14 publications

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“…Over the past 20 years, there has been increasing clinical evidence that anticoagulants have antitumour effects reducing the risk of cancer in patients with VTE and improving survival in patients with advanced malignancy (Zacharski et al, 1981;Schulman and Lindmarker, 2000;Kakkar et al, 2004). Cancer patients with VTE are at increased risk of second malignancies, but further work is needed before specific guidelines for their management would be appropriate.…”

Section: Discussionmentioning

confidence: 99%

The risk of a second cancer after hospitalisation for venous thromboembolism

et al. 2005

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Although venous thromboembolism (VTE) is common in patients with cancer, it is not known if it is associated with risk of a second malignancy. Using the Danish Cancer Registry and National Registry of Patients, we studied a population-based cohort of 6285 patients with cancer who had an episode of VTE. The risk of a second cancer was compared with that among 30 713 cancer patients without VTE, matched for age, sex, cancer site and year of diagnosis. Overall, the relative risk for a second cancer diagnosis was 1.3 (95% confidence interval (CI) 1.1 -1.4). However, the excess risk varied with the time from the initial cancer diagnosis to the thrombotic event. If the thrombotic episode occurred within the first year, the relative risk for a second cancer was 1.0 (95% CI 0.9 -1.3), but if the VTE occurred more than 1 year after the initial cancer, the overall relative risk for a second cancer was 1.4 (95% CI 1.2 -1.7), with strong associations for cancers of the digestive organs, ovary and prostate. The association between VTE and subsequent incident cancer extends to patients who already have had a cancer diagnosis.

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Section: Discussionmentioning

confidence: 99%

The risk of a second cancer after hospitalisation for venous thromboembolism

et al. 2005

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“…Carcinoma cells invade surrounding tissue and form metastases (Kogha, 1978). Fibrin formation may represent a defence mechanism against tumour invasion (Zacharski et al, 1981). Cancer may induce production of TFPI as a means of inhibiting coagulation by the host.…”

Section: Discussionmentioning

confidence: 99%

Elevated TFPI in malignant disease: relation to cancer type and hypercoagulation

Iversen¹,

Lindahl²,

Abildgaard³

1998

Br J Haematol

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Summary.We have previously reported high levels of the coagulation inhibitor TFPI in the blood of patients with gastrointestinal cancer. TFPI is not an acute-phase reactant, but high levels have also been reported in patients with septicaemia and disseminated intravascular coagulation (DIC). To study its relationship with other types of malignancy, TFPI activity was first determined in plasma samples from 214 patients with various malignancies. In a second cohort of 83 patients, total and free TFPI antigen, protein C, antithrombin, fibrin monomer and D-dimer were also measured. Elevated TFPI activity and antigens were found in about half of the patients with solid tumours. In contrast, elevated TFPI was rare in haematological malignancies (12%). In the 18 patients with acute nonlymphocytic leukaemia (ANLL), elevated free TFPI was found only in patients who also had DIC. No correlation was found between TFPI levels and fibrin monomer or D-dimer levels. Only four out of 20 patients with solid tumours had normal levels of fibrin monomer and D-dimer, yet three out of these four had elevated TFPI. In conclusion, elevated TFPI in ANLL is related to the coexistence of DIC. In solid tumour disease increased TFPI may reduce protective fibrin formation, but the pathogenic mechanism is as yet unknown.

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“…The first prospective randomized clinical trial testing the efficacy of warfarin administration on the survival of patients with cancer was published in 1981 by Zacharski et al [17] . This study included 100 patients with small cell carcinoma of the lung (SCLC) undergoing chemotherapy.…”

Section: Treatment With Vka and Survival In Patients With Cancermentioning

confidence: 99%

Clinical Studies with Anticoagulants to Improve Survival in Cancer Patients

Gerotziafas¹,

Papageorgiou²,

Hatmi³

et al. 2007

Pathophysiol Haemos Thromb

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Cancer is linked with hypercoagulability and risk of thrombosis and this close association was recognized by Armand Trousseau in 1865. The relation between cancer and blood coagulation is reciprocal: cancer induces a hypercoagulable state and predisposes to thrombosis and activation of platelets, blood coagulation and fibrinolysis interfere with tumor cell biology, tumor growth, angiogenesis and metastatic process. In the present article, we analyze the clinical trials which assessed the influence of anticoagulant treatment on the survival of patients with cancer. The available data show that low-molecular-weight heparins (LMWHs) tend to be more effective and safer than vitamin K antagonists (VKA) in improving survival in patients with cancer. The beneficial effect of anticoagulation with either LMWHs or VKA is not universal for all patients with cancer. There are some histological types of cancers which, at early stages, appear to be more sensitive than others to the effect of anticoagulant treatment. The available clinical trials, although limited, are encouraging for the beneficial effect of anticoagulant treatment on the survival of cancer patients. More clinical trials are needed, targeting groups of patients homogenous regarding the type of cancer, the stage of the disease and life expectancy. The forthcoming clinical trials have to address some issues regarding the optimal dose, the timing and the duration of treatment with LMWH in relation to chemotherapy or other anticancer therapies.

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Effect of Warfarin on Survival in Small Cell Carcinoma of the Lung

Cited by 161 publications

References 14 publications

The risk of a second cancer after hospitalisation for venous thromboembolism

The risk of a second cancer after hospitalisation for venous thromboembolism

Elevated TFPI in malignant disease: relation to cancer type and hypercoagulation

Clinical Studies with Anticoagulants to Improve Survival in Cancer Patients

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