Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism

Dalene M. Bott-Kitslaar, Robert D McBane, Ana I. Casanegra, Damon E. Houghton, David A. Froehling, Danielle T. Vlazny, Aneel Arjun Ashrani, David O. Hodge, Emily R. Vargas, Matthew A. Bartlett, Rayya A. Saadiq, Paul R. Daniels, Raymond C. Shields, Charles J. Lenz, Teresa R. Lang, Waldemar E. Wysokinski

Research output: Contribution to journalArticle

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Abstract

Objective: To compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE). Patients and Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB. Results: Within the group of 1696 patients with VTE enrolled, 600 (38%) were treated either with apixaban (n=302, 50%) or rivaroxaban (n=298, 50%) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3%) treated with apixaban and in 6 (2%) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95% CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6%) receiving apixaban and in 9 patients (3.0%) receiving rivaroxaban (aHR, 1.2; 95% CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3%) receiving apixaban and in 20 (6.7%) receiving rivaroxaban (aHR, 0.4; 95% CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95% CI, 0.3-1.2). Most study events occurred in patients with cancer. Conclusion: In the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable.

Original languageEnglish (US)
JournalMayo Clinic proceedings
DOIs
StatePublished - Jan 1 2019

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Venous Thromboembolism
Hemorrhage
Safety
apixaban
Rivaroxaban
Thrombophilia
Registries
Therapeutics
Guidelines
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bott-Kitslaar, D. M., McBane, R. D., Casanegra, A. I., Houghton, D. E., Froehling, D. A., Vlazny, D. T., ... Wysokinski, W. E. (2019). Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism. Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2018.09.022

Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism. / Bott-Kitslaar, Dalene M.; McBane, Robert D; Casanegra, Ana I.; Houghton, Damon E.; Froehling, David A.; Vlazny, Danielle T.; Ashrani, Aneel Arjun; Hodge, David O.; Vargas, Emily R.; Bartlett, Matthew A.; Saadiq, Rayya A.; Daniels, Paul R.; Shields, Raymond C.; Lenz, Charles J.; Lang, Teresa R.; Wysokinski, Waldemar E.

In: Mayo Clinic proceedings, 01.01.2019.

Research output: Contribution to journalArticle

Bott-Kitslaar, DM, McBane, RD, Casanegra, AI, Houghton, DE, Froehling, DA, Vlazny, DT, Ashrani, AA, Hodge, DO, Vargas, ER, Bartlett, MA, Saadiq, RA, Daniels, PR, Shields, RC, Lenz, CJ, Lang, TR & Wysokinski, WE 2019, 'Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism', Mayo Clinic proceedings. https://doi.org/10.1016/j.mayocp.2018.09.022
Bott-Kitslaar DM, McBane RD, Casanegra AI, Houghton DE, Froehling DA, Vlazny DT et al. Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism. Mayo Clinic proceedings. 2019 Jan 1. https://doi.org/10.1016/j.mayocp.2018.09.022
Bott-Kitslaar, Dalene M. ; McBane, Robert D ; Casanegra, Ana I. ; Houghton, Damon E. ; Froehling, David A. ; Vlazny, Danielle T. ; Ashrani, Aneel Arjun ; Hodge, David O. ; Vargas, Emily R. ; Bartlett, Matthew A. ; Saadiq, Rayya A. ; Daniels, Paul R. ; Shields, Raymond C. ; Lenz, Charles J. ; Lang, Teresa R. ; Wysokinski, Waldemar E. / Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism. In: Mayo Clinic proceedings. 2019.
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abstract = "Objective: To compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE). Patients and Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB. Results: Within the group of 1696 patients with VTE enrolled, 600 (38{\%}) were treated either with apixaban (n=302, 50{\%}) or rivaroxaban (n=298, 50{\%}) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3{\%}) treated with apixaban and in 6 (2{\%}) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95{\%} CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6{\%}) receiving apixaban and in 9 patients (3.0{\%}) receiving rivaroxaban (aHR, 1.2; 95{\%} CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3{\%}) receiving apixaban and in 20 (6.7{\%}) receiving rivaroxaban (aHR, 0.4; 95{\%} CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95{\%} CI, 0.3-1.2). Most study events occurred in patients with cancer. Conclusion: In the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable.",
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T1 - Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism

AU - Bott-Kitslaar, Dalene M.

AU - McBane, Robert D

AU - Casanegra, Ana I.

AU - Houghton, Damon E.

AU - Froehling, David A.

AU - Vlazny, Danielle T.

AU - Ashrani, Aneel Arjun

AU - Hodge, David O.

AU - Vargas, Emily R.

AU - Bartlett, Matthew A.

AU - Saadiq, Rayya A.

AU - Daniels, Paul R.

AU - Shields, Raymond C.

AU - Lenz, Charles J.

AU - Lang, Teresa R.

AU - Wysokinski, Waldemar E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE). Patients and Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB. Results: Within the group of 1696 patients with VTE enrolled, 600 (38%) were treated either with apixaban (n=302, 50%) or rivaroxaban (n=298, 50%) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3%) treated with apixaban and in 6 (2%) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95% CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6%) receiving apixaban and in 9 patients (3.0%) receiving rivaroxaban (aHR, 1.2; 95% CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3%) receiving apixaban and in 20 (6.7%) receiving rivaroxaban (aHR, 0.4; 95% CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95% CI, 0.3-1.2). Most study events occurred in patients with cancer. Conclusion: In the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable.

AB - Objective: To compare the clinical efficacy and safety of apixaban with those of rivaroxaban for the treatment of acute venous thromboembolism (VTE). Patients and Methods: Consecutive patients enrolled in the Mayo Thrombophilia Clinic Registry (between March 1, 2013, and January 30, 2018) and treated with apixaban or rivaroxaban for acute VTE were followed forward in time. The primary efficacy outcome was VTE recurrence. The primary safety outcome was major bleeding; the second safety outcome was clinically relevant nonmajor bleeding (CRNMB); and the third was a composite of major bleeding or CRNMB. Results: Within the group of 1696 patients with VTE enrolled, 600 (38%) were treated either with apixaban (n=302, 50%) or rivaroxaban (n=298, 50%) within the first 14 days of VTE diagnosis and who completed at least 3 months of therapy or had a study event. Recurrent VTE was diagnosed in 7 patients (2.3%) treated with apixaban and in 6 (2%) treated with rivaroxaban (adjusted hazard ratio [aHR], 1.4; 95% CI, 0.5-3.8). Major bleeding occurred in 11 patients (3.6%) receiving apixaban and in 9 patients (3.0%) receiving rivaroxaban (aHR, 1.2; 95% CI, 0.5-3.2). Clinically relevant nonmajor bleeding was diagnosed in 7 patients (2.3%) receiving apixaban and in 20 (6.7%) receiving rivaroxaban (aHR, 0.4; 95% CI, 0.2-0.9). The rates of composite major bleeding or CRNMB were similar (aHR, 0.6; 95% CI, 0.3-1.2). Most study events occurred in patients with cancer. Conclusion: In the setting of a standardized, guideline-directed, patient-oriented clinical practice, the efficacy and safety of apixaban and rivaroxaban for the treatment of acute VTE were comparable.

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