Evidence map›Paper›PMID 41553598›Full record

ArticleDrug safety2026

Risk of Cancer Comparing Warfarin and Direct Oral Anticoagulants: Population-Based Cohort Studies in England and Hong Kong.

Zixuan Wang, Qiuyan Yu, Julian Matthewman, John Tazare, Sara Benitez Majano, Jeremy Brown, Ka Shing Cheung, Celine S L Chui, Esther W Y Chan, Krishnan Bhaskaran and 3 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Drug safety, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Zixuan WangDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0001-5345-2471
Qiuyan YuLaboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China.ORCID http://orcid.org/0000-0002-5385-7185
Julian MatthewmanDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0003-3291-2381
John TazareDepartment of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0002-7194-2615
Sara Benitez MajanoDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0001-8032-9794
Jeremy BrownDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0002-9941-7759
Ka Shing CheungDepartment of Medicine, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.ORCID http://orcid.org/0000-0002-4838-378X
Celine S L ChuiLaboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China.ORCID http://orcid.org/0000-0003-1513-8726
Esther W Y ChanLaboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China.ORCID http://orcid.org/0000-0002-7602-9470
Krishnan BhaskaranDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0001-5364-8757
Ian C K WongLaboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China.ORCID http://orcid.org/0000-0001-8242-0014
Ian J DouglasDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.ORCID http://orcid.org/0000-0002-8970-1406
Angel Y S WongDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK. angel.wong@lshtm.ac.uk.ORCID http://orcid.org/0000-0002-8618-7333

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrevious 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.

objectiveWe aimed to examine the association between cancer and warfarin, compared with active comparator (direct oral anticoagulants).

methodsWe 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.

resultsNo 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.

conclusionsThis 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.

Indexed as

AnticoagulantsAtrial FibrillationNeoplasmsWarfarinAdministration, OralAgedAged, 80 and overCohort StudiesEnglandFemaleHong KongHumansMaleMiddle AgedRisk FactorsAnticoagulantsWarfarin

Identifiers

PMID41553598

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.