For patients with venous thromboembolism (VTE) continuing warfarin or direct oral anticoagulants (DOACs) beyond six months, the risk for recurrent VTE is lower with DOACs, according to a study published online Aug. 15 in JAMA Network Open.
Margaret C. Fang, M.D., M.P.H., from the University of California in San Francisco, and colleagues compared the rates of recurrent VTE, hospitalizations for hemorrhage, and all-cause death among adults prescribed DOACs or warfarin beyond six months after acute VTE.
Patients with a diagnosis of incident VTE during 2010 to 2018 were followed from the end of the initial six-month treatment period until discontinuation of anticoagulation, occurrence of an outcome event, health plan disenrollment, or end of follow-up (Dec. 31, 2019). Data were included for 18,495 patients with VTE: 11.5 and 88.5 percent received DOAC therapy and warfarin therapy, respectively.
The researchers found that for patients receiving DOACs versus warfarin, unadjusted event rates were lower for recurrent VTE (event rate per 100 person-years, 2.92 [95 percent confidence interval (CI)], 2.29 to 3.54] versus 4.14 [95 percent CI, 3.90 to 4.38]), hospitalizations for hemorrhage (1.02 [95 percent CI, 0.66 to 1.39] versus 1.81 [95 percent CI, 1.66 to 1.97]), and all-cause death (3.79 [95 percent CI, 3.09 to 4.49] versus 5.40 [95 percent CI, 5.13 to 5.66]).
DOAC treatment was associated with a lower risk for recurrent VTE after multivariable adjustment (adjusted hazard ratio, 0.66; 95 percent CI, 0.52 to 0.82). The risks for hospitalization for hemorrhage and all-cause death did not differ significantly for those receiving DOAC treatment versus warfarin treatment.
“Our study contributes to the growing evidence supporting the use of DOACs for both initial and extended treatment of VTE in terms of clinical outcomes as well as treatment satisfaction,” the authors write.
One author disclosed ties to Epi Excellence; a second author disclosed ties to the pharmaceutical industry.
Margaret C. Fang et al, Clinical Outcomes of Direct Oral Anticoagulants vs Warfarin for Extended Treatment of Venous Thromboembolism, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.28033
JAMA Network Open
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