Hemorrhage risk of direct oral anticoagulants in real-world venous thromboembolism patients

IntroductionVenous thromboembolism (VTE) management increasingly involves anticoagulation with direct oral anticoagulants (DOACs). Few studies have used competing-risks analyses to ascertain the mortality-adjusted hemorrhage and recurrent VTE (rVTE) risk of individual DOACs. Furthermore, factors in patients treated apixaban remain underexplored.Materials methodsPatients diagnosed receiving were identified from Optum Clinformatics Data Mart (2003–2019). Study endpoints included readmissions for intracranial (ICH), non-intracranial (non-ICH hemorrhage), rVTE. Coarsened exact matching was balance baseline clinical characteristics. Complication incidence evaluated using a framework. We additionally modeled apixaban-treated patients.ResultsOverall, 225,559 included, whom 34,201 received 46,007 rivaroxaban. Compared rivaroxaban, associated decreased non-ICH (sHR = 0.560, 95%CI 0.423–0.741), but not ICH, rVTE 0.802, 0.651–0.988) risk. This primarily emergent (sHR[emergent hemorrhage] 0.515, 0.372–0.711; sHR[emergent rVTE] 0.636, 0.488–0.830).Contributors include older age 1.025, 1.011–1.039), female sex 1.662, 1.252–2.207), prior prescription antiplatelet therapy 1.591, 1.130–2.241), complicated hypertension 1.936, 1.134–3.307). Patients anticipated be “high-risk” experienced elevated ICH 3.396, 1.375–8.388) 3.683, 2.957–4.588) incidence.ConclusionsIn anticoagulation, reduced risk, compared Risk reduction restricted readmissions. present risk-stratification approach predict apixaban, potentially guiding future decision-making.