Extended anticoagulation with apixaban reduced recurrent VTE compared to no extended treatment (HR 0.10; 95% CI 0.04-0.26) and had fewer major bleeding events than warfarin.
Cohort (n=14,818)
Does extended oral anticoagulant treatment with apixaban or warfarin reduce the risk of recurrent VTE and major bleeding events in patients with VTE who completed 6-month initial treatment?
In a real-world setting, extended anticoagulation with apixaban effectively reduces recurrent VTE risk without increasing major bleeding compared to no treatment, offering a superior safety profile to warfarin.
Effect estimate: HR 0.10 (95% CI 0.04-0.26)
Limited real-world evidence exists for effectiveness and safety of extended oral anticoagulation beyond 6 months of initial treatment in prevention of recurrent venous thromboembolism (VTE) and adverse major bleeding events among patients with VTE. Using MarketScan Commercial and Medicare Supplemental databases (2013-2019), we conducted a retrospective cohort study to compare the risk of recurrent VTE and major bleeding events during extended treatment among patients with VTE who completed the 6-month initial treatment and received extended oral anticoagulant treatment with apixaban, warfarin, or no extended treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards modeling with inverse probability treatment weighting. We identified 14,818 patients with extended treatment of apixaban (n = 4,338), warfarin (n = 5,298), or no extended treatment (n = 5,182). Compared with no extended treatment, apixaban use was associated with decreased risk of recurrent VTE (HR: 0.10, 95% CI: 0.04-0.26) without increased risk of major bleeding events (HR: 1.06, 95% CI: 0.52-2.17); warfarin use was associated with decreased risk of recurrent VTE (HR: 0.23, 95% CI: 0.12-0.44) but with increased risk of major bleeding events (HR: 2.64, 95% CI: 1.51-4.59). Compared with warfarin, apixaban use was associated with decreased risk of major bleeding events (HR: 0.42, 95% CI: 0.22-0.80) but no difference in risk of recurrent VTE (HR: 0.46, 95% CI: 0.15-1.36). In a real-world clinical setting, extended anticoagulation with apixaban or warfarin was associated with decreased risk of recurrent VTE compared with no extended treatment, and apixaban had a better safety profile with fewer major bleeding events compared with warfarin among commercially insured patients with VTE.
Kang et al. (Thu,) conducted a cohort in Venous Thromboembolism (n=14,818). Apixaban or warfarin vs. No extended treatment was evaluated on Recurrent VTE (HR 0.10, 95% CI 0.04-0.26). Extended anticoagulation with apixaban reduced recurrent VTE compared to no extended treatment (HR 0.10; 95% CI 0.04-0.26) and had fewer major bleeding events than warfarin.