Bleeding and recurrent VTE with apixaban vs warfarin as outpatient treatment: time-course and subgroup analyses. Blood Adv 2020 Jan 28;4(2):432-439
Date
01/29/2020Pubmed ID
31990332Pubmed Central ID
PMC6988406DOI
10.1182/bloodadvances.2019001081Scopus ID
2-s2.0-85082202520 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
In the phase 3 trial Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-Line Therapy, apixaban was noninferior to enoxaparin, overlapped and followed by warfarin, in the treatment of venous thromboembolism (VTE) with significantly less bleeding; in a real-world evaluation, risks for bleeding and recurrent VTE were lower with apixaban vs warfarin plus parenteral anticoagulant (PAC) bridge therapy. The present study extends this research by comparing outcomes over time and within selected subgroups. A retrospective observational cohort design and 4 US private health care claims databases were used. Study population included patients who initiated outpatient treatment with apixaban or warfarin (plus PAC bridge therapy) for VTE. Major bleeding, clinically relevant nonmajor (CRNM) bleeding, and recurrent VTE were compared during the 180-day follow-up period, at selected follow-up time points (days 21, 90, 180), and within subgroups (pulmonary embolism [PE] with or without deep vein thrombosis [DVT], DVT only, provoked VTE, unprovoked VTE) using multivariable shared frailty models. Study population consisted of 20 561 apixaban patients and 35 080 warfarin patients; baseline characteristics were comparable. Overall, at selected follow-up time points, and within the aforementioned subgroups, adjusted risks were lower among apixaban vs warfarin patients: major bleeding, by 27% to 39%, CRNM bleeding, by 17% to 28%, and recurrent VTE, by 25% to 39% (all P ≤ .01). In this real-world study of VTE patients, risks of bleeding and recurrent VTE were lower among apixaban (vs warfarin) patients during the 180-day follow-up period, at selected follow-up time points, and within subgroups defined by index VTE episode.
Author List
Weycker D, Wygant GD, Guo JD, Lee T, Luo X, Rosenblatt L, Mardekian J, Atwood M, Hanau A, Cohen ATMESH terms used to index this publication - Major topics in bold
AgedAmbulatory Care
Female
Follow-Up Studies
Hemorrhage
Humans
Male
Middle Aged
Pyrazoles
Pyridones
Recurrence
Retrospective Studies
Venous Thromboembolism
Warfarin