Study Compares Risk of Adverse Events for Medications in Management of VTE

Bea S, Iyer GS, Kim DH, et al. Oral Anticoagulation and Risk of Adverse Clinical Outcomes in Venous Thromboembolism. JAMA Intern Med. 2025; in press.

This study compared effectiveness of warfarin, apixaban, and rivaroxaban as treatments for prevention of recurrence or bleeding events after initial management of venous thromboembolism (VTE).

The authors used data from the Medicare database and two commercial insurance databases to evaluate rates of rehospitalization for recurrent VTE or significant bleeding events in patients (n = 163,593) who had one of the anticoagulants initiated within 30 days of hospital discharge after initial treatment of VTE; follow up of at least one year was required.

Apixaban was used in 58.5% of patients; rivaroxaban and warfarin were used in 25.7% and 15.8%, respectively. Compared with warfarin, recurrence and bleeding event rates were lower for apixaban and rivaroxaban. Apixaban had the lowest rates of recurrence and bleeding events. These findings were consistent across subgroups defined by gender, cancer diagnosis, kidney disease, bleeding history, and frailty.

The authors recommended using these data to guide the selection of long-term anticoagulant therapy for patients with VTE.