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DOACs appear better than warfarin for extended anticoagulation after VTE

Reuters Health - 15/03/2022 - The direct oral anticoagulants (DOACs) apixaban or rivaroxaban may be better options than warfarin for extended oral anticoagulant therapy after venous thromboembolism (VTE), new research suggests.

Guidelines for managing VTE recommend at least 90 days of therapy with oral anticoagulants, but limited evidence exists about the optimal drug for continuing therapy beyond 90 days, the researchers note in their JAMA report.

To investigate, they analyzed data for more than 64,000 older adults who initiated oral anticoagulation after discharge for VTE and continued treatment beyond 90 days.

They found that apixaban, compared with warfarin, beyond 90 days was associated with a significantly lower rate of hospitalization for recurrent VTE (9.8 vs. 13.5 per 1,000 person-years; hazard ratio, 0.69), with no significant difference in the rate of hospitalization for major bleeding.

There were no significant differences in the rate of hospitalization for recurrent VTE or major bleeding with extended anticoagulation when comparing apixaban with rivaroxaban or rivaroxaban with warfarin.

Limitations of the analysis include use of administrative claims data and the potential for misclassification, the lack of information on drug doses and whether patients adhered to their anticoagulant regimen.

Despite these limitations, the results provide "some evidence that extending treatment after 90 days with apixaban vs warfarin may be beneficial," write Dr. Ajinkya Pawar and colleagues of Brigham and Women's Hospital and Harvard Medical School, in Boston.

They caution that the study had "limited statistical power to detect small, but clinically important, differences between these treatments." Therefore, more data are needed before definitive conclusions can be made regarding the relative benefits and risks of apixaban compared with rivaroxaban and of rivaroxaban versus warfarin.

The work was supported by a grant from the federal Patient-Centered Outcomes Research Institute (PCORI). Some of the authors report financial ties to drugmakers.

SOURCE: https://bit.ly/3KKJQp8 JAMA, online March 15, 2022.

By Reuters Staff

© 2023 The Author(s). Published by Medicom Medical Publishers.
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