Apixaban and Rivaroxaban in Patients With Acute Venous Thromboembolism

Bott-Kitslaar, Dalene; McBane, Robert D.; Casanegra, Ana I.; Houghton, Damon E.; Froehling, David A.; Vlazny, Danielle T.; Ashrani, Aneel A.; Hodge, David O.; Vargas, Emily; Bartlett, Matthew; Saadiq, Rayya A.; Daniels, Paul; Shields, Raymond C.; Lenz, Charles J.; Lang, Teresa R.; Wysokiński, Waldemar E.

doi:10.1016/j.mayocp.2018.09.022

Cited by 26 publications

(39 citation statements)

References 19 publications

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“…A work flow system involving the Thrombophilia Clinic and Vascular Radiology personnel utilized to maximize patient care, and assure uniformity of clinical practice, has been previously described . Templated, continuously updated information about available FDA‐approved anticoagulants for Ca‐VTE, including rivaroxaban and apixaban, is provided with a standardized script for providers, and a short summary table with medication characteristics for the patient.…”

Section: Methodsmentioning

confidence: 99%

“…For patients requiring an invasive procedure, pre‐procedural apixaban and rivaroxaban were withheld for 48 hours, and rivaroxaban 72 hours, for high bleeding risk procedures . For patients receiving enoxaparin, the last dose was reduced to 1 mg/kg and given 24 hours prior to the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…The primary effectiveness outcome was symptomatic, recurrent, adjudicated VTE defined as deep vein thrombosis (DVT) or PE as previously described . In order to be classified as a recurrent event, there had to be a new filling defect evident on the second study, not appreciated on the original images, or an interval study clearly showing thrombus resolution.…”

Section: Methodsmentioning

confidence: 99%

“…In the current study we compare VTE recurrence, survival, and bleeding rates in patients with acute Ca‐VTE treated with apixaban, rivaroxaban or LMWH (all patients received enoxaparin). This was using a clinical setting characterized by maximal standardization of evidence‐based practice, anticoagulant selection based on patient characteristics (ability to take medication once or twice a day, renal function), and organized, continuous, prospective follow up …”

Section: Introductionmentioning

confidence: 99%

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Comparison of apixaban to rivaroxaban and enoxaparin in acute cancer‐associated venous thromboembolism

et al. 2019

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To provide direct comparison between apixaban and rivaroxaban in patients with acute cancer‐associated venous thromboembolism (Ca‐VTE), consecutive patients treated with apixaban, rivaroxaban, or enoxaparin at Mayo Thrombophilia Clinic (March 1, 2013 to January 31, 2018)) were followed prospectively. The primary effectiveness outcome was venous thromboembolism (VTE) recurrence, and the secondary was mortality. The primary safety outcome was major bleeding, the secondary clinically relevant safety outcome was non‐major bleeding (CRNMB), and the third a composite of major and CRNMB. There were 750 patients treated for acute Ca‐VTE with apixaban (n = 224), rivaroxaban (n = 163), and enoxaparin (n = 363) within 14 days of diagnosis and for at least 3 months, or until study event. Recurrent VTE was diagnosed in 11 receiving apixaban, 7 receiving rivaroxaban (apixaban vs rivaroxaban hazard ratio (HR) 1.31, 95% confidence interval (95% CI) 0.51‐3.36) and 17 in the enoxaparin receiving group (apixaban vs enoxaparin HR 1.14, 95% CI: 0.54, 2.42 and rivaroxaban vs enoxaparin HR 0.85, 95% Cl: 0.36, 2.06). There were 82 deaths in apixaban, 74 rivaroxaban (apixaban vs rivaroxaban HR 1.67, 95% Cl: 1.20, 2.33) and 171 in enoxaparin group (rivaroxaban vs enoxaparin HR 0.73, 95% Cl: 0.56, 0.96). Major bleeding occurred in 11 apixaban, 12 rivaroxaban (apixaban vs rivaroxaban HR 0.73, 95% Cl: 0.32, 1.66) and 21 enoxaparin group (apixaban vs enoxaparin HR 0.89, 95% Cl: 0.43, 1.84 and rivaroxaban vs enoxaparin HR 1.23, 95% Cl: 0.61, 2.50). The CRNMB rate was higher in rivaroxaban compared to apixaban (P = .03) and LMWH (P = .01) groups. Recurrence of VTE and major bleeding were similar in apixaban, rivaroxaban, and enoxaparin groups. Rivaroxaban was associated with higher CRNMB but lower mortality compared to apixaban and enoxaparin.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of apixaban to rivaroxaban and enoxaparin in acute cancer‐associated venous thromboembolism

et al. 2019

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“…Patients with an acute VTE are systematically referred to the Mayo Clinic Gonda Vascular Center Thrombophilia Clinic in a streamlined process that has been previously described 19 . When a patient has positive testing for acute VTE the radiologist interpreting the study contacts the Thrombophilia Clinic and the patient is immediately evaluated.…”

Section: Methodsmentioning

confidence: 99%

Treatment of upper extremity deep vein thrombosis with apixaban and rivaroxaban

et al. 2020

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Randomized controlled trials leading to the approval of apixaban and rivaroxaban for venous thromboembolism (VTE) did not include patients with upper extremity deep vein thrombosis (UE‐DVT). We sought to evaluate the safety and effectiveness of rivaroxaban and apixaban for the treatment of acute UE‐DVT. Consecutive patients with VTE enrolled into the Mayo Clinic VTE Registry, between March 1, 2013 and December 31, 2019, were followed prospectively. Clinical, demographic and imaging data were collected at the time of study recruitment. Patients with a diagnosis of acute UE‐DVT who received rivaroxaban, apixaban, LMWH or warfarin were included. Recurrent VTE, major bleeding, clinical‐relevant non‐major bleeding (CRNMB), and death were assessed at 3‐month intervals. During the study period, 210 patients with acute UE‐DVT were included; 63 were treated with apixaban, 39 with rivaroxaban, and 108 with LWMH and/or warfarin. Overall 51% had catheter‐associated UE‐DVT, 60% had a diagnosis of malignancy, and 14% had concurrent pulmonary embolism. Malignancy was more common in patients treated with LMWH/warfarin (67% vs 52%, P = .03). At 3 months of follow up, one (0.9%) recurrent VTE occurred in a patient treated with LMWH/warfarin and one (1.0%) patient treated with apixaban or rivaroxaban (P = .97). Major bleeding occurred in three patients treated with LMWH/warfarin, and in none of those treated with apixaban or rivaroxaban (P = .09). Clinical‐relevant non‐major bleeding occurred in one patient (0.9%) treated with LWMH/warfarin and two patients (2.0%) treated with apixaban or rivaroxaban (P = .53). Treatment of UE‐DVT with apixaban or rivaroxaban appears to be as safe and effective as LMWH/warfarin.

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