Apixaban was associated with a lower 1-year composite risk of recurrent VTE or death (HR 0.86) and reduced major bleeding (HR 0.73) compared to warfarin in older adults with acute VTE.
Does apixaban or rivaroxaban reduce recurrent VTE, death, and bleeding compared to warfarin in older adults with acute VTE?
In older adults with acute VTE, apixaban demonstrated a more favorable balance of effectiveness, safety, and home-time preservation compared to warfarin, whereas rivaroxaban showed no clear advantage.
Absolute Event Rate: 0% vs 0%
ABSTRACT In this retrospective cohort of 18 066 Medicare fee‐for‐service beneficiaries ≥ 65 years with acute VTE (2015–2019), we compared apixaban, rivaroxaban, and warfarin using propensity score (PS) overlap weighting and intention‐to‐treat analyses across total, non‐frail, and frail strata defined by a claims‐based frailty index. After PS weighting (all SMDs < 0.10), apixaban versus warfarin was associated with a lower 1‐year composite of recurrent VTE or death in the total population (189.1 versus 216.1 per 1000 PY; HR 0.86, 95% CI 0.77–0.96), with benefit evident in non‐frail patients (114.5 versus 143.6; HR 0.78, 0.66–0.92) and attenuated in frail patients (330.9 versus 349.9; HR 0.93, 0.82–1.07). Recurrent VTE rates favored apixaban but were not statistically significant overall (40.5 versus 54.8; HR 0.86, 0.68–1.08). Major bleeding was lower with apixaban (19.4 versus 26.0; HR 0.73, 0.53–1.00). Home‐time loss was reduced with apixaban compared with warfarin in the total population (mean 54.9 versus 67.0 days; RR 0.89, 0.83–0.96) and was directionally similar across both frailty strata. Rivaroxaban showed no clear advantage over warfarin for the composite (216.9 versus 216.1; HR 1.00, 0.90–1.11) or bleeding (HR 0.99, 0.73–1.32) and yielded greater home‐time loss than apixaban (RR 1.08, 1.01–1.17). Overall, apixaban demonstrated the most favorable balance of effectiveness, safety, and patient‐centered benefit, with patterns generally consistent across frailty levels.
Park et al. (Thu,) reported a other. Apixaban was associated with a lower 1-year composite risk of recurrent VTE or death (HR 0.86) and reduced major bleeding (HR 0.73) compared to warfarin in older adults with acute VTE.