Comparative effectiveness and safety of apixaban vs. rivaroxaban in patients with cirrhosis and portal vein thrombosis

BACKGROUND: Portal vein thrombosis (PVT) occurs in ~14% of patients with cirrhosis. Although apixaban and rivaroxaban are increasingly used in this population, comparative data are lacking. METHODS: We conducted a retrospective cohort study of adults with cirrhosis and PVT initiating apixaban or rivaroxaban. Propensity score matching (3 : 1) was used to balance baseline characteristics. The effectiveness outcome was a composite of hepatic decompensation or recurrent PVT and the safety outcome was a composite of gastrointestinal or intracranial bleeding. Cox proportional hazard models estimated hazard ratios (HRs). RESULTS: After matching, 312 patients were included (206 apixaban, 106 rivaroxaban). Use of apixaban (vs. rivaroxaban) was associated with similar effectiveness [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.50-2.06] and lower risk of bleeding (HR 0.62, 95% CI 0.19-2.12), although CI crossed the null value of 1. CONCLUSIONS: In this real-world cohort, apixaban and rivaroxaban demonstrated comparable effectiveness, with possible lower bleeding risk with apixaban.