Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis

• Type of Material: Article
• Authors: Neil A Zakai, University of Vermont; Rob F Walker, University of Minnesota, Minneapolis; Richard F MacLehose, University of Minnesota, Minneapolis; Insu Koh, University of Vermont; Alvaro Alonso, Emory University; Pamela L Lutsey, University of Minnesota, Minneapolis
• Language: English
• Date: 2021-08-01
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/rth2.12575
• Title of Journal or Parent Work: RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS
• Volume: 5
• Issue: 6
• Start Page: e12575
• End Page: e12575
• Grant/Funding Information: This study was funded by grants R01HL131579 (PI Lutsey), R01‐HL122200 (PI Alonzo), and K24‐HL148521 (PIA) and from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
• Keywords: EXTENDED TREATMENT; PATIENT; EDOXABAN; ADHERENCE; Hematology; THROMBOEMBOLISM; DISEASE; Science & Technology; venous thromboembolism; warfarin; IMPACT; Life Sciences & Biomedicine; THERAPY; anticoagulants; factor Xa inhibitors; secondary prevention; Cardiovascular System & Cardiology; Peripheral Vascular Disease; OUTCOMES
• Research Categories: Health Sciences, Epidemiology

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.