Apixaban a safe oral anticoagulant choice for VTE patients

For patients with venous thromboembolism (VTE) who are initiating an oral anticoagulant, apixaban use appears to be safer than rivaroxaban and warfarin, with lower risks of VTE recurrence and major bleeding, as reported in a study.

Researchers used data from Medicare and two commercial insurance databases to identify adult patients who initiated an oral anticoagulant within 30 days after VTE onset and had at least 1 year of continuous insurance enrolment before the index date.

A total of 163,593 patients (mean age 71.4 years, 56.7 percent female) met the eligibility criteria and were included in the analysis. Of the patients, 58.5 percent initiated apixaban, 25.7 percent initiated rivaroxaban, and 15.8 percent initiated warfarin.

Overall, 3,270 hospitalizations for recurrent VTE (the primary effectiveness outcome) and 4,229 hospitalizations for bleeding events (the primary safety outcome) occurred. The risk of recurrent VTE was lower with apixaban (hazard ratio [HR], 0.67, 95 percent confidence interval [CI], 0.61–0.75) and rivaroxaban (HR, 0.77, 95 percent CI, 0.69–0.87) relative to warfarin. Notably, apixaban was also associated with reduced VTE recurrence risk when compared with rivaroxaban (HR, 0.87, 95 percent CI, 0.78–0.96).

Likewise, apixaban was associated with a lower risk of major bleeding compared with warfarin (HR, 0.70, 95 percent CI, 0.64–0.76) and rivaroxaban (HR, 0.69, 95 percent CI, 0.63–0.75). Meanwhile, the risk did not differ significantly between rivaroxaban and warfarin (HR, 1.02, 95 percent CI, 0.92–1.12).

The results were consistent across subgroups defined by age, sex, cancer, chronic kidney disease, bleeding history, and frailty.

Overall, the present data may be used to guide the selection of appropriate initial oral anticoagulant regimens for adult patients with VTE.