Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis
Abstract Background Venous thromboembolism (VTE) affects nearly 1 million Americans annually, and many benefit from continued anticoagulation after the initial 3‐ to 6‐month treatment period (secondary prevention). Objectives To determine whether warfarin, apixaban, or rivaroxaban is associated with...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12575 |
| _version_ | 1797766632660008960 |
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| author | Neil A. Zakai Rob F. Walker Richard F. MacLehose Insu Koh Alvaro Alonso Pamela L. Lutsey |
| author_facet | Neil A. Zakai Rob F. Walker Richard F. MacLehose Insu Koh Alvaro Alonso Pamela L. Lutsey |
| author_sort | Neil A. Zakai |
| collection | DOAJ |
| description | Abstract Background Venous thromboembolism (VTE) affects nearly 1 million Americans annually, and many benefit from continued anticoagulation after the initial 3‐ to 6‐month treatment period (secondary prevention). Objectives To determine whether warfarin, apixaban, or rivaroxaban is associated with reduced recurrent VTE hospitalization in the secondary prevention of VTE. Patients/Methods We performed a retrospective cohort study of participants enrolled in the MarketScan Insurance Database between 2013 and 2017 in those with an incident VTE. In those individuals who continued oral anticoagulation (warfarin, apixaban, or rivaroxaban) beyond 6 months, we determined the relative rate of recurrent VTE hospitalization. Results Among 119 964 individuals with VTE, 25 419 remained on anticoagulation after 6 months and were matched successfully by age, sex, and date. After adjusting for a propensity score, apixaban versus rivaroxaban (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.45‐0.94) and apixaban versus warfarin (HR, 0.68; 95% CI, 0.47‐1.00) had a reduced risk of recurrent VTE hospitalization, and rivaroxaban versus warfarin (HR, 1.12; 95% CI, 0.94‐1.33) had equivalent rates. For the rivaroxaban versus warfarin comparison there was a significant interaction by renal function (P < .01) where rivaroxaban was associated with a lower risk of recurrent VTE hospitalization (HR, 0.65; 95% CI, 0.41‐1.03) in those with kidney disease and increased risk in those without kidney disease (HR, 1.24; 95% CI, 1.02‐1.50). Conclusions These data suggest that apixaban has a lower recurrent VTE hospitalization rate than rivaroxaban during the secondary prevention of VTE, and further study of diverse patient populations, especially by kidney function, is warranted. |
| first_indexed | 2024-03-12T20:26:59Z |
| format | Article |
| id | doaj.art-086d8a79f47c45259c4386b436d23652 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T20:26:59Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-086d8a79f47c45259c4386b436d236522023-08-02T00:22:27ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792021-08-0156n/an/a10.1002/rth2.12575Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosisNeil A. Zakai0Rob F. Walker1Richard F. MacLehose2Insu Koh3Alvaro Alonso4Pamela L. Lutsey5Department of Medicine Larner College of Medicine at the University of Vermont Burlington Vermont USADivision of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis Minnesota USADivision of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis Minnesota USADepartment of Pathology and Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington Vermont USADepartment of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia USADivision of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis Minnesota USAAbstract Background Venous thromboembolism (VTE) affects nearly 1 million Americans annually, and many benefit from continued anticoagulation after the initial 3‐ to 6‐month treatment period (secondary prevention). Objectives To determine whether warfarin, apixaban, or rivaroxaban is associated with reduced recurrent VTE hospitalization in the secondary prevention of VTE. Patients/Methods We performed a retrospective cohort study of participants enrolled in the MarketScan Insurance Database between 2013 and 2017 in those with an incident VTE. In those individuals who continued oral anticoagulation (warfarin, apixaban, or rivaroxaban) beyond 6 months, we determined the relative rate of recurrent VTE hospitalization. Results Among 119 964 individuals with VTE, 25 419 remained on anticoagulation after 6 months and were matched successfully by age, sex, and date. After adjusting for a propensity score, apixaban versus rivaroxaban (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.45‐0.94) and apixaban versus warfarin (HR, 0.68; 95% CI, 0.47‐1.00) had a reduced risk of recurrent VTE hospitalization, and rivaroxaban versus warfarin (HR, 1.12; 95% CI, 0.94‐1.33) had equivalent rates. For the rivaroxaban versus warfarin comparison there was a significant interaction by renal function (P < .01) where rivaroxaban was associated with a lower risk of recurrent VTE hospitalization (HR, 0.65; 95% CI, 0.41‐1.03) in those with kidney disease and increased risk in those without kidney disease (HR, 1.24; 95% CI, 1.02‐1.50). Conclusions These data suggest that apixaban has a lower recurrent VTE hospitalization rate than rivaroxaban during the secondary prevention of VTE, and further study of diverse patient populations, especially by kidney function, is warranted.https://doi.org/10.1002/rth2.12575anticoagulantsfactor Xa inhibitorssecondary preventionvenous thromboembolismwarfarin |
| spellingShingle | Neil A. Zakai Rob F. Walker Richard F. MacLehose Insu Koh Alvaro Alonso Pamela L. Lutsey Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis Research and Practice in Thrombosis and Haemostasis anticoagulants factor Xa inhibitors secondary prevention venous thromboembolism warfarin |
| title | Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| title_full | Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| title_fullStr | Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| title_full_unstemmed | Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| title_short | Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| title_sort | venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis |
| topic | anticoagulants factor Xa inhibitors secondary prevention venous thromboembolism warfarin |
| url | https://doi.org/10.1002/rth2.12575 |
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