420 Background: Patients with gastric cancer complicated by venous thromboembolism (VTE) often require anticoagulation. This study aims to compare safety and effectiveness of apixaban versus rivaroxaban in this setting. Methods: Using the TriNetX US Collaborative Network, we identified adults with gastric cancer and VTE who received either apixaban or rivaroxaban. Propensity score matching was applied, yielding two balanced cohorts (n=1,266 each). Outcomes assessed included mortality, gastrointestinal (GI) bleeding, intracranial bleeding, recurrent pulmonary embolism (PE), deep vein thrombosis (DVT), and stroke. Kaplan–Meier survival analyses with log-rank tests and hazard ratios (HRs) were performed. Results: Mortality was similar between apixaban and rivaroxaban groups (33.2% vs 36.4%, HR 1.07, 95% CI 0.96–1.20, p=0.245). Risks of upper/lower GI bleeding (HR 0.93, 95% CI 0.78–1.11, p=0.429), intracranial bleeding (HR 1.49, 95% CI 0.78–2.85, p=0.229), DVT (HR 0.92, 95% CI 0.81–1.06, p=0.257), and stroke (HR 1.13, 95% CI 0.82–1.56, p=0.439) did not differ significantly. However, recurrent PE was more frequent with apixaban (44.6% vs 52.1%, HR 1.19, 95% CI 1.06–1.34, p=0.004). Conclusions: In gastric cancer patients with VTE, apixaban and rivaroxaban demonstrated comparable safety profiles for bleeding and most thrombotic outcomes. Rivaroxaban was associated with a lower risk of recurrent PE, while mortality rates were similar. These findings suggest both agents are reasonable options, though rivaroxaban may offer an advantage in preventing PE recurrence.
Zahid et al. (Sat,) studied this question.
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