Schaefer Jordan K, Errickson Josh, Kong Xiaowen, Ali Mona A, Chipalkatti Naina, Haymart Brian, Kaatz Scott, Krol Gregory D, Sood Suman L, Froehlich James B, Barnes Geoffrey D
Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Consulting for Statistics, Computing, & Analytics Research, University of Michigan, Ann Arbor, Michigan, USA.
JACC Adv. 2025 May;4(5):101714. doi: 10.1016/j.jacadv.2025.101714. Epub 2025 Apr 25.
Apixaban and rivaroxaban are commonly used direct oral anticoagulants for atrial fibrillation (AF) and venous thromboembolism (VTE). Both have been compared to warfarin, but there are insufficient comparative outcome data.
The purpose of this study was to assess outcomes of apixaban, rivaroxaban, and warfarin.
This is a registry-based cohort study with data from 6 centers in Michigan, 2009 to 2023. Patients were adults with AF and/or VTE with at least 3 months of follow-up. Outcomes included rates of bleeding, thrombosis, healthcare utilization, and death.
A total of 13,435 patients met the study inclusion criteria (average age 66.7 years, 58.0% on anticoagulation for AF, average follow-up 28.2 months). After matching, 2 groups of 3,527 patients on apixaban and warfarin were compared. Any bleeding was similar between groups, but major bleeding was less with apixaban. Thrombotic event rates were higher with apixaban. Mortality, rates of emergency room visits, and hospitalizations for bleeding were higher with warfarin. After matching, 1,395 patients on rivaroxaban were compared to 4,185 patients on warfarin. Any bleeding and major bleeding were higher with rivaroxaban. Thrombotic event rates were similar, aside from a higher rate of "other" thrombosis with rivaroxaban. After matching, 2 groups of 1,395 patients on apixaban and rivaroxaban were compared. Any bleeding, major bleeding, and mortality were higher with rivaroxaban. Thrombotic event rates were similar.
For patients with AF and/or VTE, we observed that bleeding was highest with rivaroxaban, followed by warfarin, and then apixaban. Rates of thrombosis were higher with apixaban than with warfarin, largely driven by "other" thrombotic events.
阿哌沙班和利伐沙班是常用于治疗心房颤动（AF）和静脉血栓栓塞症（VTE）的直接口服抗凝剂。两者均已与华法林进行过比较，但比较结果数据不足。
本研究的目的是评估阿哌沙班、利伐沙班和华法林的治疗效果。
这是一项基于登记处的队列研究，数据来自密歇根州6个中心，时间为2009年至2023年。患者为患有AF和/或VTE的成年人，随访至少3个月。结果包括出血、血栓形成、医疗保健利用和死亡发生率。
共有13435名患者符合研究纳入标准（平均年龄66.7岁，58.0%因AF接受抗凝治疗，平均随访28.2个月）。匹配后，比较了两组各3527名接受阿哌沙班和华法林治疗的患者。两组间任何出血情况相似，但阿哌沙班导致的大出血较少。阿哌沙班的血栓形成事件发生率较高。华法林导致的死亡率、急诊就诊率和出血住院率较高。匹配后，将1395名接受利伐沙班治疗的患者与4185名接受华法林治疗的患者进行比较。利伐沙班导致的任何出血和大出血发生率较高。血栓形成事件发生率相似，但利伐沙班的“其他”血栓形成发生率较高。匹配后，比较了两组各1395名接受阿哌沙班和利伐沙班治疗的患者。利伐沙班导致的任何出血、大出血和死亡率较高。血栓形成事件发生率相似。
对于患有AF和/或VTE 的患者，我们观察到利伐沙班导致的出血最多，其次是华法林，然后是阿哌沙班。阿哌沙班的血栓形成发生率高于华法林，主要由“其他 ”血栓形成事件所致。
