A Comparison of Outcomes With Apixaban, Rivaroxaban, and Warfarin for Atrial Fibrillation and/or Venous Thromboembolism.
Document Type
Article
Publication Date
4-16-2025
Publication Title
JACC. Advances
Abstract
BACKGROUND: 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.
OBJECTIVES: The purpose of this study was to assess outcomes of apixaban, rivaroxaban, and warfarin.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Volume
4
Issue
5
First Page
101714
Recommended Citation
Schaefer JK, Errickson J, Kong X, Ali MA, Chipalkatti N, Haymart B et al A comparison of outcomes with apixaban, rivaroxaban, and warfarin for atrial fibrillation and/or venous thromboembolism. JACC Adv. 2025 Apr 16;4(5):101714. doi: 10.1016/j.jacadv.2025.101714. Epub ahead of print. PMID: 40286370.
DOI
10.1016/j.jacadv.2025.101714
ISSN
2772-963X
PubMed ID
40286370
