To evaluate 6-month all-cause mortality by anticoagulant prescribed for primary treatment of venous thromboembolism (VTE) in Medicare beneficiaries with noncancer VTE.
Key Findings:
Patients prescribed rivaroxaban had lower mortality rates (HR = 0.82; 95% CI, 0.76-0.90) compared to those prescribed warfarin.
No significant mortality difference was found between apixaban and warfarin (HR = 0.96; 95% CI, 0.87-1.07).
In head-to-head comparisons, rivaroxaban had a higher risk compared to apixaban (HR = 1.14; 95% CI, 1.01-1.28).
Findings were consistent among patients with liver and kidney disease.
Interpretation:
Rivaroxaban may be associated with lower mortality compared to warfarin, while apixaban shows similar mortality risk to warfarin. Further research is needed to confirm the safety of DOACs in patients with concomitant kidney or liver disease.
Limitations:
Potential residual confounding may affect results.
Limited generalizability due to the exclusion of certain patient subgroups in clinical trials.
The impact of residual confounding on the study's conclusions should be considered.
Conclusion:
The study suggests that rivaroxaban may be a safer option than warfarin for treating VTE, particularly in patients with kidney or liver disease, although further research is needed.
