TUESDAY, Sept. 5, 2023 (HealthDay News) — Apixaban has a lower bleeding risk than warfarin or rivaroxaban during initial treatment for patients with venous thromboembolism (VTE), according to a study published online Aug. 28 in the Journal of Internal Medicine.

Katarina Glise Sandblad, from the University of Gothenburg in Sweden, and colleagues compared major bleeding rates by choice of anticoagulation during the initial six months of treatment and extended treatment (up to five years) for VTE. The analysis included cancer-free patients with a first-time VTE between 2014 and 2020.

The researchers found that during initial treatment, major bleeding rates were 3.86 per 100 patient-years for warfarin, 2.93 for rivaroxaban, and 1.95 for apixaban, yielding adjusted hazard ratios (aHRs) of 0.89 (95 percent confidence interval [CI], 0.71 to 1.12) for rivaroxaban versus warfarin, 0.55 (95 percent CI, 0.43 to 0.71) for apixaban versus warfarin, and 0.62 (95 percent CI, 0.50 to 0.76) for apixaban versus rivaroxaban. Major bleeding rates during extended treatment were 1.55 per 100 patient-years for warfarin, 1.05 for rivaroxaban, and 0.96 for apixaban, with aHRs of 0.72 (95 percent CI, 0.53 to 0.99) for rivaroxaban versus warfarin, 0.60 (95 percent CI, 0.44 to 0.82) for apixaban versus warfarin, and 0.85 (95 percent CI, 0.64 to 1.12) for apixaban versus rivaroxaban. During both initial and extended treatment, previous bleeding and increasing age were risk factors for bleeding.

“It is important to keep in mind that patients included in the analysis on extended treatment were free of major bleeding during initial treatment, which could contribute to the low bleeding incidence,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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