Physicians' Academy for Cardiovascular Education

Less hospitalizations for recurrent VTE with extended treatment of DOAC

Association of Type of Oral Anticoagulant Dispensed With Adverse Clinical Outcomes in Patients Extending Anticoagulation Therapy Beyond 90 Days After Hospitalization for Venous Thromboembolism

Literature - Pawar A, Gagne JJ, Gopalakrishnan C, et al. - JAMA. 2022;327(11):1051-1060.

Introduction and methods


VTE has a substantial morbidity and mortality, and warfarin has long been the only oral anticoagulant to manage VTE [1,2]. Nowadays , though, 4 direct oral anticoagulants (DOACs) are widely used. Extended treatment (> 90 days) has been assessed in various studies, but there has been no direct comparison of DOACs with warfarin or against each other [3-7].

Aim of the study

This study compared extended prescription dispenses for the two DOACs apixaban and rivaroxaban, and warfarin for the outcomes of hospitalization for VTE recurrence, hospitalization for major bleeding events, and mortality.


This was an exploratory retrospective cohort study including 64,642 adults who initiated oral anticoagulation following hospitalization discharge for VTE and continued treatment beyond 90 days. Data were derived from three health claims databases in the US. Of the included patients, 9,167 patients had apixaban, 12,468 patients had rivaroxaban, and 43,007 patients had warfarin. For recurrent VTE, median follow-up was 109 (IQR: 59-228 ) days. For major bleeding, median follow-up was 108 (IQR: 58-226) days. Propensity score matching weights were used to correct for non-random allocation of patients to treatment groups.


The primary outcome of the study was hospitalization for recurrent VTE and hospitalization for major bleeding. Secondary outcome was all-cause mortality.

Main results


In patients who filled prescriptions for extended therapy with oral anticoagulants after hospitalization for VTE, prescription dispenses for apixaban > 90 days in comparison with warfarin > 90 days, were significantly associated with a modestly lower rate of hospitalization for recurrent VTE. There was no significant difference in rate of hospitalization for major bleeding or all-cause mortality when comparing patients prescribed apixaban with patients prescribed warfarin.


Show references

Find this article online at JAMA

Share this page with your colleagues and friends: