Which Direct-Acting Oral Anticoagulant Is Best for Preventing Recurrent Venous Thromboembolism?

Direct-acting oral anticoagulants (DOACs) have demonstrated superiority compared with warfarin in safety and efficacy for treating patients with venous thromboembolism (VTE). However, individual DOACs have not been compared head to head, so evidence on efficacy and bleeding has been limited to observational studies. In this latest observational study, researchers examined diagnosis codes from Medicare and commercial insurance databases for 160,000 adults started on oral anticoagulation (apixaban, rivaroxaban, or warfarin) after hospitalization for new-onset VTE. Those with end-stage renal disease were excluded.

During median follow-up of ≈6 months, apixaban recipients were significantly less likely than rivaroxaban and warfarin recipients to be hospitalized for VTE recurrence (23 vs. 27 and 38 per 1000 person-years, respectively) or to be hospitalized for bleeding (31 vs. 45 and 47 per 1000 person-years). All-cause mortality was similar in the three groups. These weighted incidences reflected statistical adjustment for potential confounding factors.