CANCER INCIDENCE AND MORTALITY IN PATIENTS WITH HEART-DISEASE - EFFECT OF ORAL ANTICOAGULANT-THERAPY

Cancer incidence and mortality were reviewed in patients (683) who, du ring the period 1969-1988, had been attending the Cardiological Center of Pisa University for more than 1 year for valvular (494), ischemic (183), or myocardial (6) disease. Oral anticoagulant therapy (tromexan , acenocoumarol or warfarin) was administered to 312 of these 693 pati ents and regulated to prolong prothrombin time to a value between 20% and 40% of normal controls. The duration of treatment ranged from 1 to 14 years, with a mean of 4 years. As clinical and radiological contro ls were performed on all the patients at regular intervals (2-12 month s), cancer incidence and mortality were recorded. Cancer incidence and mortality in the 312 patients treated with anticoagulants were compar ed with that of the 381 patients who did not receive this therapy. Fur thermore, cancer mortality in the patients on anticoagulants was compa red to that expected on the basis of national tumor registry rates. Th e age of the patients varied from 20 or under to 80 or over in both gr oups. The total observation period was 1415 patient-years (555 for mal es and 860 for females) in the former and 1617 patient-years (735 male s and 882 females) in the latter. The proportion of the patient-years of the men over 45 (with the highest risk of cancer mortality) was hig her in the group treated with anticoagulants (83%) than in the control s (72%) (p < .001). The proportion of the patient-years of the women o ver 45 was also higher in the former (84% vs 62%; p < .001). Six cance rs were observed in the patients treated with oral anticoagulants (3 m en, 3 women), while 12 cancers occurred in the control group (9 men, 3 women). There were 3 deaths in the former (1 man, 2 women) and 6 in t he latter (5 men, 1 woman). On the basis of the national tumor registr y rates, deaths expected in men and women on oral anticoagulants were 3 and 2. These data are compatible with the hypothesis that oral antic oagulants might reduce cancer incidence and mortality in humans.