JAMA Intern Med

Apixaban edges out warfarin and rivaroxaban in VTE outcomes

June 2, 2025

Study details: This large population-based cohort study analyzed 163,593 adults (mean age 71.4 years; 56.7% female) with venous thromboembolism (VTE) using Medicare and commercial insurance data from 2016–2024. Patients initiated apixaban (58.5%), rivaroxaban (25.7%), or warfarin (15.8%) within 30 days post-discharge. Propensity score–weighted Cox models assessed risks of recurrent VTE and major bleeding.

Results: Compared with warfarin, both apixaban (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.61–0.75) and rivaroxaban (HR, 0.77; 95% CI, 0.69–0.87) were associated with lower risk of recurrent VTE. Apixaban further reduced VTE recurrence risk compared with rivaroxaban (HR, 0.87; 95% CI 0.78–0.96). For major bleeding, apixaban had lower risk than both warfarin (HR, 0.70; 95% CI, 0.64–0.76) and rivaroxaban (HR, 0.69; 95% CI, 0.63–0.75), while rivaroxaban and warfarin had similar bleeding risk. Findings were consistent across subgroups, including older adults, those with cancer, CKD, prior bleeding, and frailty.

Clinical impact: The findings reinforce current guidelines favoring direct oral anticoagulants over warfarin for VTE treatment, with apixaban emerging as the preferred agent for most patients due to its superior safety and efficacy profile.

Source:

Bea S, et al. (2025, May 12). JAMA Intern Med. Oral Anticoagulation and Risk of Adverse Clinical Outcomes in Venous Thromboembolism. https://pubmed.ncbi.nlm.nih.gov/40354043/