Key result
Apixaban was associated with a lower risk of major bleeding compared to warfarin during initial VTE treatment (aHR 0.55; 95% CI 0.43-0.71).
Why the study?
Safety data for different anticoagulant medications in venous thromboembolism are scarce, particularly for extended treatment.
Does apixaban or rivaroxaban reduce major bleeding compared to warfarin in cancer-free patients with first-time VTE?
Cohort (n=45,114)
Yes
Does apixaban or rivaroxaban reduce major bleeding compared to warfarin in cancer-free patients with first-time VTE?
Hazard Ratio: 0.55 (95% CI 0.43–0.71)
Absolute Event Rate: 1.95% vs 3.86%
Apixaban is associated with a lower risk of major bleeding compared to warfarin and rivaroxaban during the first 6 months of VTE treatment, while both apixaban and rivaroxaban have lower bleeding risks than warfarin during extended treatment.
May support initial apixaban preference to lower bleeding in VTE; extends observational data but leaves practice change to RCTs.
BACKGROUND: Safety data for different anticoagulant medications in venous thromboembolism (VTE) are scarce, in particular for extended treatment. OBJECTIVES: To compare major bleeding rates depending on the choice of anticoagulation during initial (first 6 months) and extended treatment (6 months up to 5 years). METHODS: A nationwide register-based study including cancer-free patients with a first-time VTE between 2014 and 2020. Cox proportional hazards models were used to compare bleeding rates. RESULTS: We included 6558 patients on warfarin, 18,196 on rivaroxaban, and 19,498 on apixaban. At 6 months, 4750 (72.4%) remained on warfarin, 11,366 (62.5%) on rivaroxaban, and 11,940 (61.2%) on apixaban. During initial treatment, major bleeding rates were 3.86 (95% CI 3.14-4.58), 2.93 (2.55-3.31), and 1.95 (1.65-2.25) per 100 patient-years for warfarin, rivaroxaban, and apixaban, respectively, yielding adjusted hazard ratios (aHRs) of 0.89 (95% CI 0.71-1.12) for rivaroxaban versus warfarin, 0.55 (0.43-0.71) for apixaban versus warfarin, and 0.62 (0.50-0.76) for apixaban versus rivaroxaban. During extended treatment, major bleeding rates were 1.55 (1.19-1.91), 1.05 (0.85-1.26), and 0.96 (0.78-1.15) per 100 patient-years for warfarin, rivaroxaban, and apixaban, respectively, with aHRs of 0.72 (0.53-0.99) for rivaroxaban versus warfarin, 0.60 (0.44-0.82) for apixaban versus warfarin, and 0.85 (0.64-1.12) for apixaban versus rivaroxaban. Previous bleeding and increasing age were risk factors for bleeding both during initial and extended treatment. CONCLUSION: Apixaban had a lower bleeding risk than warfarin or rivaroxaban during initial treatment. During extended treatment, bleeding risk was similar for apixaban and rivaroxaban, and higher with warfarin.
No takes yet. Share an insight, caveat, or question.
Sandblad et al. (2023) conducted a cohort in venous thromboembolism (n=45,114). Apixaban vs. Warfarin was evaluated on Major bleeding during initial treatment (first 6 months) (aHR 0.55, 95% CI 0.43-0.71). Apixaban was associated with a lower risk of major bleeding compared to warfarin during initial VTE treatment (aHR 0.55; 95% CI 0.43-0.71).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: