Effectiveness and Safety of Rivaroxaban Versus Warfarin in Frail Patients with Venous Thromboembolism.

Link to article at PubMed

Effectiveness and Safety of Rivaroxaban Versus Warfarin in Frail Patients with Venous Thromboembolism.

Am J Med. 2018 Mar 08;:

Authors: Coleman CI, Turpie AGG, Bunz TJ, Beyer-Westendorf J

Abstract
PURPOSE: Frailty predicts poorer outcomes in patients receiving anticoagulation. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin in frail patients experiencing venous thromboembolism in routine practice.
METHODS: Using United States MarketScan claims data from 1/2012-12/2016, we identified frail patients (using the Johns Hopkins Claims-Based Frailty Indicator score) who had ≥1 primary hospitalization/emergency department visit discharge diagnosis code for venous thromboembolism (index event), received rivaroxaban or warfarin as their first outpatient oral anticoagulant (OAC) within 30-days of the index event and had ≥12-month of insurance coverage prior the index venous thromboembolism (baseline). Differences in baseline covariates between cohorts were adjusted using inverse probability of treatment weights based on propensity-scores (with residual standardized differences <0.1 achieved for all covariates after adjustment). The primary endpoint was the composite of recurrent venous thromboembolism or major bleeding. Patient claims were tracked for up to 12-months after the index venous thromboembolism or until endpoint occurrence OAC discontinuation or switch, insurance disenrollment or end-of-follow-up. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS: Of 58,089 incident venous thromboembolism patients identified, 6,869 (1,365 rivaroxaban and 5,504 warfarin users) were classified as frail. Rivaroxaban reduced patients' hazard of the composite of recurrent venous thromboembolism or major bleeding (HR=0.75, 95%CI=0.57-0.98) and recurrent venous thromboembolism alone (HR=0.65, 95%CI=0.44-0.97) compared to warfarin. No significant difference in major bleeding was observed between cohorts (HR=0.88, 95%CI=0.61-1.27).
CONCLUSIONS: Frail patients experiencing an venous thromboembolism and given rivaroxaban experience less recurrent venous thromboembolism, with at least as good bleeding outcomes, as patients prescribed warfarin.

PMID: 29526541 [PubMed - as supplied by publisher]

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