Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

Pamela L Lutsey, Neil A. Zakai, Richard F Maclehose, Faye Norby, Rob F. Walker, Nicholas S. Roetker, Terrence J Adam, Alvaro Alonso

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29 Scopus citations


Understanding of the comparative bleeding risks of oral anticoagulant (OAC) therapies for the primary treatment of venous thromboembolism (VTE) is limited. Therefore, among anticoagulant-naïve VTE patients, we conducted comparisons of apixaban, rivaroxaban and warfarin on the rate of hospitalised bleeding within 180 days of OAC initation. MarketScan databases for the time-period from 2011 to 2016 were used and, for each OAC comparison, new users were matched with up to five initiators of a different OAC. The final analysis included 83 985 VTE patients, who experienced 1944 hospitalised bleeding events. In multivariable-adjusted Cox regression models, rate of hospitalised bleeding was lower among new users of apixaban when compared to new users of rivaroxaban [hazard ratio (95% confidence interval) 0·58 (0·41–0·80)] or warfarin [0·68 (0·50–0·92)]. Overall, the hospitalised bleeding rate was similar when comparing new users of rivaroxaban to new users of warfarin [0·98 (0·68–1·11)], though there was some suggestion that rivaroxaban was associated with lower bleeding risk among younger individuals. Findings from this large real-world population concur with results from the randomised trial which found lower bleeding risk with apixaban versus warfarin and, for the first time, reveal a lower risk of bleeding in a comparison of apixaban versus rivaroxaban.

Original languageEnglish (US)
Pages (from-to)903-911
Number of pages9
JournalBritish journal of haematology
Issue number5
StatePublished - Jun 2019

Bibliographical note

Funding Information:
This work was supported by NIH National Heart Lung and Blood Institute grants R01-HL131579 and R01-HL122200.

Publisher Copyright:
© 2019 British Society for Haematology and John Wiley & Sons Ltd


  • apixaban
  • comparative effectiveness
  • oral anticoagulant
  • rivaroxaban
  • venous thromboembolism


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