Risk of Hospitalised Bleeding in Comparisons of Oral Anticoagulant Options for the Primary Treatment of Venous Thromboembolism

Details

• Personal Author:
  Adam TJ ; Alonso A ; Lutsey PL ; MacLehose RF ; Norby FL ; Roetker NS ; Walker RF ; Zakai NA
• Description:
  Understanding of the comparative bleeding risks of oral anticoagulant (OAC) therapies for the primary treatment of venous thromboembolism (VTE) is limited. Therefore, among anticoagulant-naïve VTE patients, we conducted comparisons of apixaban, rivaroxaban and warfarin on the rate of hospitalised bleeding within 180 days of OAC initation. MarketScan databases for the time-period from 2011 to 2016 were used and, for each OAC comparison, new users were matched with up to five initiators of a different OAC. The final analysis included 83 985 VTE patients, who experienced 1944 hospitalised bleeding events. In multivariable-adjusted Cox regression models, rate of hospitalised bleeding was lower among new users of apixaban when compared to new users of rivaroxaban [hazard ratio (95% confidence interval) 0·58 (0·41-0·80)] or warfarin [0·68 (0·50-0·92)]. Overall, the hospitalised bleeding rate was similar when comparing new users of rivaroxaban to new users of warfarin [0·98 (0·68-1·11)], though there was some suggestion that rivaroxaban was associated with lower bleeding risk among younger individuals. Findings from this large real-world population concur with results from the randomised trial which found lower bleeding risk with apixaban versus warfarin and, for the first time, reveal a lower risk of bleeding in a comparison of apixaban versus rivaroxaban. [Description provided by NIOSH]
• Subjects:
  Blood Drug Therapy Hematologic Tests Occupational Health Safety
• Keywords:
  Anticoagulants Apixaban Author Keywords: Venous Thromboembolism Blood Disorders Blood Vessels Circulatory System Comparative Effectiveness Drug Therapy Hematology Medical Treatment Medicinal Chemicals Oral Anticoagulant Rivaroxaban

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• ISSN:
  0007-1048
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Minnesota ; OSHA Region 1 ; OSHA Region 4 ; OSHA Region 5 ; Vermont
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  185
• Issue:
  5
• NIOSHTIC Number:
  nn:20064497
• Citation:
  Br J Haematol 2019 Jun; 185(5):903-911
• Contact Point Address:
  Pamela L. Lutsey, Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA
• Email:
  lutsey@umn.edu
• CAS Registry Number:
  (±)-Warfarin (CAS RN 81-81-2) ; Apixaban (CAS RN 503612-47-3) ; Rivaroxaban (CAS RN 366789-02-8)
• Federal Fiscal Year:
  2019
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  British Journal of Haematology
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:4a7b7d1bf89b18f8ee3a01b2d1df00e8e5b5933444798da01986e1b72bb06f4413ef6354994be3be4a0cfd9d5f19502c429753f3346983d61c8602f358746bd6
• Download URL:
  https://stacks.cdc.gov/view/cdc/222949/cdc_222949_DS1.pdf
• File Type:
  [PDF - 303.21 KB ]