Study supports extended DOAC treatment for venous thromboembolism

For patients with venous thromboembolism (VTE) who are prescribed to undergo anticoagulation beyond 6 months, continued direct oral anticoagulant (DOAC) treatment is associated with a lower risk of VTE recurrence compared with continued warfarin, as reported in a study.

For the study, researchers used data from two integrated healthcare delivery systems in California, US. The study population comprised 18,495 patients (29.6 percent ≥75 years of age, 48.5 percent women) with VTE who were treated with at least 6 months of anticoagulation, of whom 2,134 (11.5 percent) were receiving DOAC therapy and 16,361 (88.5 percent) were receiving warfarin therapy.

Out of a total 3,214.9 total person-years of DOAC exposure time, 2,563.9 person-years (79.8 percent) were on dabigatran, 462.0 person-years (14.4 percent) were on rivaroxaban, and 188.9 person-years (5.9 percent) were on apixaban. Compared with warfarin users, DOAC users received treatment for a longer period (median duration, 14.9 vs 10.8 months) and tended to be younger, male, and non-Hispanic.

Patients receiving DOAC therapy than warfarin therapy had much lower event rates for recurrent VTE (2.92 vs 4.14 per 100 person-years), hospitalizations for haemorrhage (1.02 vs 1.81 per 100 person-years), and all-cause death (3.79 vs 5.40 per 100 person-years).

Multivariable Cox proportional hazards regression analysis showed that DOAC treatment was associated with a significantly lower risk of VTE recurrence (adjusted hazard ratio [aHR], 0.66, 95 percent confidence interval [CI], 0.52–0.82) compared with warfarin therapy. No significant differences were seen in the risks of hospitalization for haemorrhage (aHR, 0.79, 95 percent CI, 0.54–1.17) and all-cause death (aHR, 0.96, 95 percent CI, 0.78–1.19).