Pulmonary vascular disease & thromboembolism
Oral Anticoagulation and Risk of Adverse Clinical Outcomes in Venous Thromboembolism
Authors' conclusion
In this cohort study of patients with VTE who initiated an oral anticoagulant, apixaban was associated with a lower risk of VTE recurrence and major bleeding compared with rivaroxaban and warfarin. These results provide evidence to guide the selection of appropriate initial oral anticoagulant regimens for adult patients with VTE.
Study context
- Population
- Patients 18 years and older who initiated an oral anticoagulant following venous thromboembolism (VTE) and had at least 1 year of continuous insurance enrollment before the index date, 2016 up to 2024
- Participants
- 163,593 eligible individuals
- Exposure
- Apixaban, rivaroxaban, and warfarin in patients with VTE
- Outcome
- Hospitalization for recurrent VTE (primary effectiveness outcome); major bleeding (primary safety outcome)
Methodological detailspropensity score-matching weights, Medicare and 2 commercial insurance databases
- Propensity score-matching weights
- Medicare and 2 commercial insurance databases
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Apixaban vs warfarinrecurrent VTE
0.67(0.61–0.75)
Rivaroxaban vs warfarinrecurrent VTE
0.77(0.69–0.87)
Apixaban vs rivaroxabanrecurrent VTE
0.87(0.78–0.96)
Apixaban vs warfarinmajor bleeding
0.70(0.64–0.76)
Apixaban vs rivaroxabanmajor bleeding
0.69(0.63–0.75)
Rivaroxaban vs warfarinmajor bleeding; no difference
1.02(0.92–1.12)
- Hospitalizations for recurrent VTE
- 3270
- Hospitalizations for bleeding events
- 4229
Observational data: associations, not effects.
Further findings
Initiation share
Subgroups by age, sex, cancer, chronic kidney disease, bleeding history, and frailty
- Findings were consistent across subgroups
Original publication
Oral Anticoagulation and Risk of Adverse Clinical Outcomes in Venous Thromboembolism. JAMA Intern Med. Published 1 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it