Written by Babatunde Carew
Spoon Feed
Apixaban is associated with lower risks of recurrent VTE and major bleeding compared to rivaroxaban and warfarin.
Blood feud – anticoagulant showdown
Understanding how oral anticoagulants compare in the management of venous thromboembolism (VTE) is key to reducing clot recurrence and bleeding risk. While DOACs have largely replaced warfarin in current practice, based on VTE guidelines and a Cochrane review, head-to-head data comparing them is still relatively limited.
This population-based cohort study evaluated 163,593 adults with VTE initiating apixaban, rivaroxaban, or warfarin. Using propensity-score-weighted analyses, apixaban was associated with lower risks of recurrent VTE and major bleeding compared with warfarin and rivaroxaban. Rivaroxaban had lower VTE recurrence than warfarin but similar bleeding risk. Limitations of this observational study include the potential for residual confounding and reliance on claims data.
How does this change my practice?
This study reinforces my preference for apixaban when initiating anticoagulation in patients with VTE, given its superior safety and efficacy profile. I will continue to prioritize it over rivaroxaban or warfarin unless contraindicated or cost prohibitive. Future studies comparing DOACs to newcomer AC agents will be interesting.
Source
Oral Anticoagulation and Risk of Adverse Clinical Outcomes in Venous Thromboembolism. JAMA Intern Med. 2025 May 12:e251109. doi: 10.1001/jamainternmed.2025.1109. Epub ahead of print. PMID: 40354043
