Effectiveness and safety of outpatient rivaroxaban versus warfarin for treatment of venous thromboembolism in patients with a known primary hypercoagulable state.
Thromb Res
; 163: 132-137, 2018 03.
Article
em En
| MEDLINE
| ID: mdl-29407625
INTRODUCTION: Screening for primary hypercoagulable states (PHSs) in venous thromboembolism (VTE) patients was not mandated in the EINSTEIN trials; and therefore, few patients with a known PHS were available for analysis. We sought to assess the effectiveness and safety of rivaroxaban versus warfarin for treatment of VTE in patients with a known PHS. METHODS: Using MarketScan claims data from 1/2012-9/2015, we identified adults with a primary diagnosis of VTE during a hospitalization/emergency department visit (the index event), with ≥180-days of continuous insurance coverage prior to the index event, a documented diagnosis for a PHS and newly-initiated as an outpatient on rivaroxaban or warfarin within 30-days of the index VTE. Rivaroxaban and warfarin users were 1:1 propensity-score matched. Balance between cohorts was evaluated by inspecting standardized differences for baseline covariates (<0.1 considered well-balanced). Patients were followed up to 12-months from the index event or until occurrence of an endpoint, switch/discontinuation of index oral anticoagulation or insurance disenrollment. Rates of recurrent VTE and major bleeding were compared using Cox regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: We matched 403 rivaroxaban and 403 warfarin patients with VTE and a known PHS. All baseline covariates had a standardized differenceâ¯<â¯0.1. Rivaroxaban use was associated with a non-significant reduction in recurrent VTE (HRâ¯=â¯0.70, 95%CIâ¯=â¯0.33-1.49) and major bleeding (HRâ¯=â¯0.55, 95%CIâ¯=â¯0.16-1.86) versus warfarin. CONCLUSIONS: In routine practice, the effectiveness and safety of rivaroxaban versus warfarin in VTE patients with a known PHS appears to be similar to that observed in the EINSTEIN trial program.
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Base de dados:
MEDLINE
Métodos Terapêuticos e Terapias MTCI:
Terapias_biologicas
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Aromoterapia
Assunto principal:
Varfarina
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Transtornos da Coagulação Sanguínea
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Tromboembolia Venosa
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Inibidores do Fator Xa
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Rivaroxabana
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Anticoagulantes
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Idioma:
En
Revista:
Thromb Res
Ano de publicação:
2018
Tipo de documento:
Article