Nakchbandi W et al. (2006) Effects of low-dose warfarin and regional chemotherapy on survival in patients with pancreatic carcinoma. Scand J Gastroenterol 41: 1095–1104

Pancreatic carcinoma is associated with thromboembolism, caused by increased levels of coagulation factors and decreased thrombolysis. Warfarin prolongs survival and improves the response to treatment in a subset of patients with small-cell carcinoma of the lung, which shows similar tumor-related activation of coagulation; Nakchbandi and colleagues, therefore, investigated whether warfarin might have similar beneficial effects in patients with pancreatic carcinoma.

Nakchbandi and colleagues retrospectively analyzed data from 180 patients with inoperable pancreatic carcinoma who had undergone one of seven different chemotherapy regimens; of these, 111 patients had also received 1.25 mg warfarin daily. The mean duration of disease from the time of initial diagnosis to presentation was 7.7 ± 0.8 months (median 4.8 months). Treatment with warfarin resulted in significantly prolonged survival of patients treated with all chemotherapy regimens—the median survival from presentation was 5.0 months with warfarin versus 2.3 months without warfarin (P <0.0001). The chemotherapy regimen associated with the longest survival included regional treatment with gemcitabine and mitomycin-C as well as systemic gemcitabine; the addition of warfarin to this regimen improved survival further (7.1 months with warfarin versus 3.6 months without warfarin; P = 0.05). Warfarin administration did not result in an increase in bleeding complications.

The authors conclude that warfarin improves survival irrespective of the chemotherapy used, and suggest that these data provide a rationale for a definitive study on the use of warfarin combined with regional and systemic chemotherapy in patients with pancreatic carcinoma.