Key result
Apixaban linked to ~24% lower major bleeding risk and similar VTE recurrence versus warfarin.
Why the study?
The AMPLIFY trial established apixaban outcomes in VTE, but comparisons of major bleeding, clinically-relevant non-major bleeding, and recurrent VTE across clinically-relevant subgroups of newly diagnosed elderly VTE patients remained to be assessed.
Does apixaban reduce major bleeding and recurrent VTE in elderly US Medicare patients with newly diagnosed VTE compared to warfarin?
Cohort (n=22,726)
Does apixaban reduce major bleeding and recurrent VTE in elderly US Medicare patients with newly diagnosed VTE compared to warfarin?
In a real-world elderly Medicare population, apixaban is associated with significantly lower bleeding risks and similar recurrent VTE risk compared to warfarin, consistent with clinical trial data.
Answers are grounded in this paper and cite their sources.
Supports apixaban consideration in elderly VTE; extends AMPLIFY trial consistency to Medicare data but remains hypothesis-generating.
BACKGROUND: The AMPLIFY trial found significantly lower major bleeding (MB) and similar recurrent venous thromboembolism (VTE) risks associated with apixaban vs warfarin among patients with VTE. OBJECTIVES: To compare MB, clinically-relevant non-major (CRNM) bleeding, and recurrent VTE risks among clinically-relevant subgroups of newly diagnosed elderly patients with VTE prescribed apixaban vs warfarin. METHODS: US Medicare patients prescribed apixaban or warfarin within 30 days post-VTE encounter were identified. Propensity score matching (PSM) was used to control for patient characteristics. Cox models were used to assess MB, CRNM bleeding, and recurrent VTE. Subgroup analyses were conducted for index VTE encounter type, index VTE diagnosis type, index VTE etiology, sex, and frailty. RESULTS: Post-PSM, 11,363 matched pairs of patients prescribed apixaban or warfarin were identified. Apixaban had lower MB (Hazard Ratio [HR]:0.76; 95% CI:0.64-0.91) and similar recurrent VTE risks (HR:1.04; 95% CI:0.75-1.43) vs warfarin. No significant interactions were observed between treatment and index VTE encounter type, index VTE diagnosis type, or sex for risk of MB, CRNM bleeding, or recurrent VTE. Significant interactions: frail patients prescribed apixaban had a 15% lower, while non-frail patients prescribed apixaban had 32% lower CRNM bleeding risk vs those prescribed warfarin. Patients with provoked VTE prescribed apixaban trended toward a higher, while those with unprovoked VTE trended toward a lower risk of recurrent VTE vs patients prescribed warfarin. CONCLUSIONS: Apixaban was associated with significantly lower risks of MB and CRNM bleeding, and similar risk of recurrent VTE as compared with warfarin across the overall population and most subgroups.
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Guo et al. (2020) conducted a cohort in Venous thromboembolism (VTE) (n=22,726). Apixaban vs. Warfarin was evaluated on Major bleeding (HR 0.76, 95% CI 0.64-0.91). Apixaban was associated with a lower risk of major bleeding and similar recurrent VTE risk compared with warfarin in Medicare VTE patients.
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