Document Type
Article
Date of Original Version
2023
Department
Computer Science and Statistics
Abstract
Background
Little to no data exist to guide treatment decision in patients with venous thromboembolism (VTE) and chronic liver disease.
Objectives
To assess the effectiveness and safety of direct oral anticoagulants (DOACs)—individually and as a class—vs warfarin and between 2 DOACs in patients with acute VTE and chronic liver disease.
Methods
We conducted a retrospective, US claims–based, propensity score–matched cohort study in adults with acute VTE and chronic liver disease who had newly initiated oral anticoagulants between 2011 and 2017. The primary outcome was a composite of hospitalization for recurrent VTE and hospitalization for major bleeding.
Results
The cohorts included 2361 DOAC-warfarin, 895 apixaban-warfarin, 2161 rivaroxaban-warfarin, and 895 apixaban-rivaroxaban matched pairs. Lower risk of the primary outcome was seen with DOACs (hazard ratio [HR], 0.72; 95% CI, 0.61-0.85), apixaban (HR, 0.48; 95% CI, 0.35-0.66) or rivaroxaban (HR, 0.73; 95% CI, 0.61-0.88) vs warfarin but not apixaban-rivaroxaban (HR, 0.68; 95% CI, 0.43-1.08). The HRs of hospitalization for major bleeding were 0.69 (95% CI, 0.57-0.84) for DOAC-warfarin, 0.43 (95% CI, 0.30-0.63) for apixaban-warfarin, 0.72 (95% CI, 0.58-0.89) for rivaroxaban-warfarin, and 0.60 (95% CI, 0.35-1.06) for apixaban-rivaroxaban. Recurrent VTE risk was lower with apixaban (HR, 0.47; 95% CI, 0.26-0.86), but not DOACs (HR, 0.81; 95% CI, 0.59-1.12) or rivaroxaban vs warfarin (HR, 0.81; 95% CI, 0.57-1.14) or apixaban-rivaroxaban (HR, 0.92; 95% CI, 0.42-2.02).
Conclusion
While the magnitude of clinical benefit varied across individual DOACs, in adults with acute VTE and chronic liver disease, oral factor Xa inhibitors (as a class or individually) were associated with lower risk of recurrent VTE and major bleeding.
Publication Title, e.g., Journal
Research and Practice in Thrombosis and Haemostasis
Volume
8
Issue
1
Citation/Publisher Attribution
Lawal, O. D., Aronow, H. D., Hume, A. L., Shobayo, F., Matson, K. L., Barbour, M.,...Wen, X. (2023). Venous thromboembolism, chronic liver disease and anticoagulant choice: effectiveness and safety of direct oral anticoagulants versus warfarin. Res. Pract. Thromb. Haemost., 8(1), e102293. https://doi.org/10.1016/j.rpth.2023.102293
Available at: https://doi.org/10.1016/j.rpth.2023.102293
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comment
Oluwadolapo D. Lawal, Anne L. Hume, Kelly L. Matson, Marilyn Barbour are affiliated with the Department of Pharmacy Practice.
Yichi Zhang is affiliated with the Department of Computer Science and Statistics.