Comparative effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with venous thromboembolism: A cohort study

Abstract

Background: Although several studies have compared the effectiveness and safety of rivaroxaban and apixaban in patients with venous thromboembolism (VTE), direct comparison of these drugs with edoxaban is lacking. Objective:We compared the effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with VTE.Patients/Methods: In this retrospective cohort study using a Japanese hospital administrative database, we identified three mutually exclusive groups of patients with VTE beginning treatment with edoxaban, rivaroxaban, or apixaban. Primary effectiveness outcome was recurrent VTE, and principal safety outcome was a composite of intracranial hemorrhage and gastrointestinal bleeding. Subjects were followed for up to 180 days. Baseline characteristics among groups were balanced using propensity score matching weights.Results: Three thousand three hundred sixty-nine edoxaban, 1592 rivaroxaban, and 1998 apixaban initiators were identified. There were no significant differences among the three drugs in the prevention of recurrent VTE (adjusted incidence rate ratio [aIRR], 0.77; 95% confidence interval [CI], 0.45-1.30 for edoxaban vs. rivaroxaban; aIRR, 0.92; 95% CI, 0.54-1.56 for edoxaban vs. apixaban; and aIRR, 1.20; 95% CI, 0.69-2.10 for rivaroxaban vs. apixaban), or in the risk of intracranial hemorrhage or gastrointestinal bleeding (aIRR, 1.57, 95% CI, 0.85-2.90 for edoxaban vs. rivaroxaban; aIRR, 1.30, 95% CI, 0.76-2.23 for edoxaban vs. apixaban; and aIRR, 0.83, 95% CI, 0.42-1.64 for rivaroxaban vs. apixaban).

Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

“…Secondly, the study was conducted with a limited number of participants at a single center. Thirdly, our study was focused on the comparison between rivaroxaban and nadroparin, and all the results concluded from this study might not be directly extrapolated to other LMWHs (e.g., enoxaparin, dalteparin) or DOACs (e.g., edoxaban, apixaban) because of the inalterability during LMWH or DOACs administration 59–65 . Finally, only patients who underwent anatomical segmentectomy or lobectomy for lung cancer were enrolled in our study.…”

“…Thirdly, our study was focused on the comparison between rivaroxaban and nadroparin, and all the results concluded from this study might not be directly extrapolated to other LMWHs (e.g., enoxaparin, dalteparin) or DOACs (e.g., edoxaban, apixaban) because of the inalterability during LMWH or DOACs administration. [59][60][61][62][63][64][65] Finally, only patients who underwent anatomical segmentectomy or lobectomy for lung cancer were enrolled in our study. A prospective, multicenter clinical trial with a larger sample of patients who undergoing other kinds of surgical procedures for lung cancer, such as wedge resection, pneumonectomy, and sleeve lobectomy, is warranted to confirm our findings.…”

Clinical Characteristics and Outcomes of Patients With Venous Thromboembolism Receiving Edoxaban in the Real World

“…We evaluated baseline patient characteristics, including demographics, comorbidities, medications, and laboratory test results, where available. 14 Active cancer was defined as at least one record of cancer that was treated with either pharmacotherapy, radiotherapy, or surgery. Renal dysfunction was defined as at least one record of renal disease or dialysis.…”

“…To account for medication stockpiling, when the period covered by 2 prescriptions overlapped, the number of overlapping days was added to the end date of the latter prescription. 14 Separate follow-up times were calculated for each outcome.…”

“…13 The structure of the database has been reported in detail elsewhere. [14][15][16] Briefly, the database contains longitudinal information on patient demographics, diagnoses coded using the International Classification of Diseases, 10th Revision (ICD-10), drug prescriptions coded using the Anatomical Therapeutic Chemical (ATC) classification system, procedures coded using the National Health Insurance reimbursement system, and laboratory results. The database can link inpatient and outpatient data, allowing for tracking of patients as long as they are treated in the same hospital.…”