Study: Eliquis Can Lower Hospitalizations after VTE

Extended use of the anticoagulant Eliquis (apixaban) was associated with a modestly lower rate of hospitalization for recurrent venous thromboembolism (VTE) compared with warfarin, but there no significant difference in rate of hospitalization for major bleeding, according to a recent study published in JAMA.

Venous thromboembolism is a disorder that includes deep vein thrombosis and pulmonary embolism. A deep vein thrombosis occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis. A pulmonary embolism occurs when a clot breaks loose and travels through the bloodstream to the lungs.

Ajinkya Pawar, PhD.

Investigators, led by Ajinkya Pawar, PhD., previously with Brigham and Women's Hospital and now director, real world investigator at Sanofi, also found there were no significant differences for comparisons of Eliquis versus Xarelto (rivaroxaban) or Xarelto versus warfarin.

Investigators compared prescriptions dispensed for Bristol Myers Squibb’s Eliquis, J&J/Bayer’s Xarelto, or warfarin after an initial 90 days of anticoagulation therapy for the outcomes of hospitalization for recurrent venous thromboembolism, major bleeding, and death. Guidelines for managing venous thromboembolism recommend at least 90 days of therapy with oral anticoagulants.

Investigators conducted an exploratory retrospective cohort study using data from fee-for-service Medicare (2009-2017) and from two commercial health insurance (2004-2018) databases. They included 64,642 adults who initiated oral anticoagulation following hospitalization discharge for venous thromboembolism and continued treatment beyond 90 days. Of these patients, 9,167 received Eliquis, 12, 468 received Xarelto, and 43,007 received warfarin. About 95% of patients continued the same oral anticoagulant that was dispensed after discharge.

In the primary cohort of patients with at least 90 days of oral anticoagulant therapy, investigators found there were 408 first hospitalizations for recurrent venous thromboembolism events, 1,513 hospitalizations for major bleeding events, and 1,633 deaths.

In the primary analysis, weighted rates of rehospitalization were 9.8 per 1,000 person-years in the Eliquis group, 11.6 for Xarelto group, and 13.5 in the warfarin group. Rates for mortality were 51.8 per 1,000 person-years for Eliquis, 53.9 for Xarelto, and 52.8 for warfarin.

For rates of hospitalization related to bleeding, there were 44.4 per 1,000 person-years for Eliquis, 50.0 for Xarelto and 47.1 for warfarin.1,000 person-years is a measurement that takes into account the number of people in a study and the time a person spends in the study.

“The low rates of hospitalization for recurrent VTE could be due to the effectiveness of these

medications or may be due to the highly specific outcome definition that required hospitalization for VTE,” investigators wrote. “Because some VTE events could be treated in an outpatient setting, these results may underestimate the incidence of recurrent VTE.”

One limitation, investigators said, was that the analysis was based on claims data and information was lacking on certain patient characteristics, such as socioeconomic status and laboratory test results, and also didn’t provide information on patient adherence. Complete mortality data were only available in the Medicare data base. Additionally, dosages of the drugs were not available.