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Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin in Patients with Venous Thromboembolism using Real-World Data: A Systematic Review and Meta-Analysis

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Abstract

Background

Direct oral anticoagulants (DOACs) have shown comparable efficacy and a superior safety profile in clinical trials for patients with venous thromboembolism (VTE). However, further study is needed to assess DOACs’ effectiveness and safety compared to warfarin in a real-world context. Thus, this meta-analysis compares the effectiveness and safety of warfarin and DOACs in patients with VTE.

Method

A systematic review of the literature using PubMed and EMBASE was conducted from inception until June 2024. We examined observational studies that compared safety and effectiveness between DOACs and warfarin when used in treating VTE and reported adjusted hazard ratios (HRs) and/or odds ratios (ORs) for recurrent VTE, major bleeding, clinically relevant non-major bleeding, gastrointestinal bleeding, intracranial hemorrhage, and death from any cause. We then estimated the pooled effect using the random-effects model for meta-analysis.

Results

A total of 25 studies were included in the current meta-analysis. DOAC therapy was associated with significantly lower risks of recurrent VTE (HR 0.76, 95% confidence interval [CI] 0.69–0.85), major bleeding (HR 0.77, 95% CI 0.72–0.83), clinically relevant non-major bleeding (HR 0.82, 95% CI 0.77–0.88), and gastrointestinal bleeding (HR 0.75, 95% CI 0.68–0.83) compared to warfarin. However, no statistically significant difference was observed in all-cause mortality between the two groups (HR 0.96, 95% CI 0.83–1.10).

Conclusion

This meta-analysis found that DOACs are associated with a significant reduction in VTE recurrence in addition to the known favorable safety profile when compared to warfarin.

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References

  1. Day ISCfWT. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost. 2014; 12:1580–1590. https://doi.org/10.1111/jth.12698.

  2. Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet. 2016;388:3060–73. https://doi.org/10.1016/s0140-6736(16)30514-1.

    Article  PubMed  Google Scholar 

  3. Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: current trends and future projections. Am J Hematol. 2011;86:217–20. https://doi.org/10.1002/ajh.21917.

    Article  PubMed  CAS  Google Scholar 

  4. Lutsey PL, Zakai NA. Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2023;20:248–62. https://doi.org/10.1038/s41569-022-00787-6.

    Article  PubMed  Google Scholar 

  5. Sepassi A, Chingcuanco F, Gordon R, Meier A, Divino V, DeKoven M, et al. Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study. J Med Econ. 2018;21:595–602. https://doi.org/10.1080/13696998.2018.1445635.

    Article  PubMed  Google Scholar 

  6. Witt DM, Clark NP, Kaatz S, Schnurr T, Ansell JE. Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism. J Thromb Thrombol. 2016;41:187–205. https://doi.org/10.1007/s11239-015-1319-y.

    Article  CAS  Google Scholar 

  7. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing G-J, Harjola V-P, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2019;41:543–603. https://doi.org/10.1093/eurheartj/ehz405.

    Article  Google Scholar 

  8. McCormack T, Harrisingh MC, Horner D, Bewley S. Venous thromboembolism in adults: summary of updated NICE guidance on diagnosis, management, and thrombophilia testing. BMJ. 2020;369: m1565. https://doi.org/10.1136/bmj.m1565.

    Article  PubMed  Google Scholar 

  9. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4:4693–738. https://doi.org/10.1182/bloodadvances.2020001830.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Stevens SM, Woller SC, Baumann Kreuziger L, Bounameaux H, Doerschug K, Geersing GJ, et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160:2247–59. https://doi.org/10.1016/j.chest.2021.07.056.

    Article  PubMed  Google Scholar 

  11. Piran S, Schulman S. Management of venous thromboembolism: an update. Thromb J. 2016;14:23. https://doi.org/10.1186/s12959-016-0107-z.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361:2342–52. https://doi.org/10.1056/NEJMoa0906598.

    Article  PubMed  CAS  Google Scholar 

  13. Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129:764–72. https://doi.org/10.1161/CIRCULATIONAHA.113.004450.

    Article  PubMed  CAS  Google Scholar 

  14. The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499–510. https://doi.org/10.1056/NEJMoa1007903.

    Article  Google Scholar 

  15. The EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. New Engl J Med. 2012;366:1287–1297. https://doi.org/10.1056/NEJMoa1113572.

  16. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369:799–808. https://doi.org/10.1056/NEJMoa1302507.

    Article  PubMed  CAS  Google Scholar 

  17. The Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369:1406–15. https://doi.org/10.1056/NEJMoa1306638.

    Article  CAS  Google Scholar 

  18. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210. https://doi.org/10.1186/s13643-016-0384-4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Langan D, Higgins JPT, Jackson D, et al. A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res Synth Methods. 2019;10(1):83–9.

    Article  PubMed  Google Scholar 

  20. Brooke BS, Schwartz TA, Pawlik TM. MOOSE reporting guidelines for meta-analyses of observational studies. JAMA Surg. 2021;156:787–8. https://doi.org/10.1001/jamasurg.2021.0522.

    Article  PubMed  Google Scholar 

  21. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. 2000.

  22. Basto AN, Fewel NP, Vo K, Stock EM, Ta M. Initiation of direct oral anticoagulants versus warfarin for venous thromboembolism: impact on time to hospital discharge. J Thromb Thrombol. 2018;45:51–5. https://doi.org/10.1007/s11239-017-1578-x.

    Article  CAS  Google Scholar 

  23. Coleman CI, Bunz TJ, Turpie AGG. Effectiveness and safety of rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism. Thromb Haemost. 2017;117:1841–7. https://doi.org/10.1160/th17-03-0210.

    Article  PubMed  Google Scholar 

  24. Jun M, Lix LM, Durand M, Dahl M, Paterson JM, Dormuth CR, et al. Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study. BMJ. 2017;359: j4323. https://doi.org/10.1136/bmj.j4323.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sindet-Pedersen C, Langtved Pallisgaard J, Staerk L, Gerds TA, Fosbøl EL, Torp-Pedersen C, et al. Comparative safety and effectiveness of rivaroxaban versus VKAs in patients with venous thromboembolism. A Danish nationwide registry-based study. Thromb Haemost. 2017;117:1182–91. https://doi.org/10.1160/th16-10-0745.

    Article  PubMed  Google Scholar 

  26. Larsen TB, Skjøth F, Kjældgaard JN, Lip GYH, Nielsen PB, Søgaard M. Effectiveness and safety of rivaroxaban and warfarin in patients with unprovoked venous thromboembolism: a propensity-matched nationwide cohort study. Lancet Haematol. 2017;4:e237–44. https://doi.org/10.1016/s2352-3026(17)30054-6.

    Article  PubMed  Google Scholar 

  27. Badreldin H. Hospital length of stay in patients initiated on direct oral anticoagulants versus warfarin for venous thromboembolism: a real-world single-center study. J Thromb Thrombol. 2018;46:16–21. https://doi.org/10.1007/s11239-018-1661-y.

    Article  CAS  Google Scholar 

  28. Roetker NS, Lutsey PL, Zakai NA, Alonso A, Adam TJ, MacLehose RF. All-cause mortality risk with direct oral anticoagulants and warfarin in the primary treatment of venous thromboembolism. Thromb Haemost. 2018;118:1637–45. https://doi.org/10.1055/s-0038-1668521.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Weycker D, Li X, Wygant GD, Lee T, Hamilton M, Luo X, et al. Effectiveness and safety of apixaban versus warfarin as outpatient treatment of venous thromboembolism in U.S. Clinical Practice. Thromb Haemost. 2018;118:1951–61. https://doi.org/10.1055/s-0038-1673689.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Al Khateep YM, Zaid NA, Salim OR. Comparative study of safety and effectiveness of rivaroxaban and warfarin in patients with acute deep venous thrombosis. Egypt J Surg. 2019;38:245–9.

    Google Scholar 

  31. Costa OS, Thompson S, Ashton V, Palladino M, Bunz TJ, Coleman CI. Rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism in African American patients: a retrospective cohort analysis. Thromb J. 2020;18:6. https://doi.org/10.1186/s12959-020-00219-w.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Dawwas GK, Smith SM, Dietrich E, Lo-Ciganic WH, Park H. Comparative effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism. Am J Health Syst Pharm. 2020;77:188–95. https://doi.org/10.1093/ajhp/zxz307.

    Article  PubMed  Google Scholar 

  33. Huang Y, Duan L, He W, Hong C, Guo Y, Wang X, et al. Efficacy and safety of rivaroxaban versus warfarin for the treatment of acute pulmonary embolism: a real-world study. Anal Cell Pathol (Amst). 2020;2020:6813492. https://doi.org/10.1155/2020/6813492.

    Article  PubMed  CAS  Google Scholar 

  34. Lee CH, Fang CC, Tsai LM, Lin HW, Chen PS, Lin SH, et al. Changing treatment patterns in patients with venous thromboembolism in Taiwan. Circ J. 2020;84:283–93. https://doi.org/10.1253/circj.CJ-19-0741.

    Article  PubMed  CAS  Google Scholar 

  35. Naqvi I, Talib A, Nayema R, Syed M, Ghazanfar R, Fatima S. Length of hospital stay in treatment of venous thromboembolism: do outcomes vary preference of anticoagulant? A retrospective analysis. Acta Haematol Polon. 2021;52:590–6.

    Article  Google Scholar 

  36. Zakai NA, Walker RF, MacLehose RF, Koh I, Alonso A, Lutsey PL. Venous thrombosis recurrence risk according to warfarin versus direct oral anticoagulants for the secondary prevention of venous thrombosis. Res Pract Thromb Haemost. 2021;5: e12575. https://doi.org/10.1002/rth2.12575.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Perino AC, Fan J, Schmitt S, Guo JD, Hlavacek P, Din N, et al. Anticoagulation treatment and outcomes of venous thromboembolism by weight and body mass index: insights from the veterans health administration. Circ Cardiovasc Qual Outcomes. 2021;14: e008005. https://doi.org/10.1161/circoutcomes.121.008005.

    Article  PubMed  Google Scholar 

  38. Pham A, Heib A, Goodman E, Cotto R, Jafari P, Lipsitz E, et al. Warfarin versus direct oral anticoagulants for patients needing distal deep vein thrombosis treatment. J Vasc Surg Venous Lymphat Disord. 2022;10:826-831.e821. https://doi.org/10.1016/j.jvsv.2022.01.006.

    Article  PubMed  Google Scholar 

  39. Cohen AT, Sah J, Dhamane AD, Hines DM, Lee T, Rosenblatt L, et al. Effectiveness and safety of apixaban vs warfarin in patients with venous thromboembolism with risk factors for bleeding or for recurrences. Adv Ther. 2023;40:1705–35. https://doi.org/10.1007/s12325-023-02440-1.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Ingason AB, Hreinsson JP, Agustsson AS, Lund SH, Rumba E, Palsson DA, et al. Warfarin is associated with higher rates of upper but not lower gastrointestinal bleeding compared with direct oral anticoagulants: a population-based propensity-weighted cohort study. Clin Gastroenterol Hepatol. 2023;21:347-357.e310. https://doi.org/10.1016/j.cgh.2022.06.033.

    Article  PubMed  CAS  Google Scholar 

  41. Guo JD, Rajpura J, Hlavacek P, Keshishian A, Sah J, Delinger R, et al. Comparative clinical and economic outcomes associated with warfarin versus apixaban in the treatment of patients with venous thromboembolism in a large U.S. Commercial Claims Database. J Manag Care Spec Pharm. 2020;26:1017–26. https://doi.org/10.1855/jmcp.2020.19311.

    Article  PubMed  Google Scholar 

  42. Guo JD, Hlavacek P, Rosenblatt L, Keshishian A, Russ C, Mardekian J, et al. Safety and effectiveness of apixaban compared with warfarin among clinically-relevant subgroups of venous thromboembolism patients in the United States Medicare population. Thromb Res. 2021;198:163–70. https://doi.org/10.1016/j.thromres.2020.11.039.

    Article  PubMed  CAS  Google Scholar 

  43. Kohn CG, Bunz TJ, Beyer-Westendorf J, Coleman CI. Comparative risk of major bleeding with rivaroxaban and warfarin: population-based cohort study of unprovoked venous thromboembolism. Eur J Haematol. 2019;102:143–9. https://doi.org/10.1111/ejh.13185.

    Article  PubMed  CAS  Google Scholar 

  44. Ramos-Isaza E, Tuta-Quintero E, Bastidas-Goyes A, et al. Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin—propensity score matching study. BMC Pharmacol Toxicol. 2023;24:77.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Fang MC, Reynolds K, Fan D, et al. Clinical outcomes of direct oral anticoagulants vs warfarin for extended treatment of venous thromboembolism. JAMA Netw Open. 2023;6(8): e2328033.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Glise Sandblad K, Schulman S, Rosengren A, Sörbo J, Philipson J, Hansson P-O. Association of type of oral anticoagulation with risk of bleeding in 45,114 patients with venous thromboembolism during initial and extended treatment—a nationwide register-based study. J Intern Med. 2023;294:743–60.

    Article  PubMed  CAS  Google Scholar 

  47. Sterne JA, Bodalia PN, Bryden PA, Davies PA, López-López JA, Okoli GN, et al. Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess. 2017;21:1–386. https://doi.org/10.3310/hta21090.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Senoo K, Kondo Y, Miyazawa K, Isogai T, Chun YH, Kobayashi Y. Safety and efficacy of direct oral anticoagulants over warfarin in Japanese patients with acute venous thromboembolism: a meta-analysis. J Cardiol. 2017;69:763–8. https://doi.org/10.1016/j.jjcc.2016.07.007.

    Article  PubMed  Google Scholar 

  49. Deitelzweig S, Bergrath E, Fusco MD, Kang A, Savone M, Cappelleri JC, et al. Real-world evidence comparing oral anticoagulants in non-valvular atrial fibrillation: a systematic review and network meta-analysis. Future Cardiol. 2022;18:393–405. https://doi.org/10.2217/fca-2021-0120.

    Article  PubMed  CAS  Google Scholar 

  50. Al Yami MS, Alzahrani MY, Alshehri AM, Alshaya OA, Alsubiae NS, Alharbi YM, et al. Real-world effectiveness and safety of apixaban versus warfarin in patients with acute venous thromboembolism: experience of a large tertiary hospital in Saudi Arabia. Int J Gen Med. 2021;14:4031–7. https://doi.org/10.2147/ijgm.S322221.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Deitelzweig S, Guo JD, Hlavacek P, Lin J, Wygant G, Rosenblatt L, et al. Hospital resource utilization and costs associated with warfarin versus apixaban treatment among patients hospitalized for venous thromboembolism in the United States. Clin Appl Thromb Hemost. 2018;24:261s–8s. https://doi.org/10.1177/1076029618800806.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Memon RA, Hamdani SSQ, Usama A, Aisha F, Kundi H, Mathavan M, et al. Comparison of the efficacy and safety of apixaban and warfarin in the prevention of stroke in patients with non-valvular atrial fibrillation: a meta-analysis. Cureus. 2022;14: e27838. https://doi.org/10.7759/cureus.27838.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Liu Z, Song D, Wang L, Wang C, Zhou J, Sun J, et al. Rivaroxaban vs. warfarin for the treatment and prevention of venous thromboembolism: a meta-analysis. Front Surg. 2023;10:1086871. https://doi.org/10.3389/fsurg.2023.1086871.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Aryal MR, Gosain R, Donato A, Yu H, Katel A, Bhandari Y, et al. Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. Blood Adv. 2019;3:2381–7. https://doi.org/10.1182/bloodadvances.2019000572.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Acknowledgements

The authors would like to extend their appreciation to King Saud University for funding this work through the Researcher Supporting Project (RSP2024R77), King Saud University, Riyadh, Saudi Arabia.

Author information

Author notes

  1. Razan S. Alshahrani: co-first author.

  2. Abdulaali R. Almutairi and Omar A. Almohammed: senior authors.

Authors and Affiliations

  1. Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Walaa A. Alshahrani, Saeed M. Alay & Majed S. Al Yami

  2. Department of Clinical Pharmacy, King Saud Medical City, Riyadh, Saudi Arabia

    Razan S. Alshahrani & Munirah A. Alkathiri

  3. Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia

    Abdulrahman M. Alabkka, Saleh A. Alaraj, Manar S. Basoodan & Omar A. Almohammed

  4. Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia

    Majed S. Al Yami

  5. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Majed S. Al Yami

  6. Drug Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia

    Waad A. Altayyar & Abdulaali R. Almutairi

  7. Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia

    Osamah M. Alfayez

  8. Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia

    Omar A. Almohammed

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Correspondence to Osamah M. Alfayez.

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Competing interests

Walaa A. Alshahrani, Razan S. Alshahrani, Munirah A. Alkathiri, Saeed M. Alay, Abdulrahman M. Alabkka, Saleh A. Alaraj, Majed S. Al Yami, Waad A. Altayyar, Osamah M. Alfayez, Manar S. Basoodan, Abdulaali R. Almutairi, and Omar A. Almohammed declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Funding

The author OAA received funds from the Researcher Supporting Project (number RSP2024R77), King Saud University, Riyadh, Saudi Arabia, to support the publication of this article. The funding agency played no role in designing the study, conducting the analysis, interpreting the data, or writing the manuscript.

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The authors declare that the article or the supplementary material contain all the data used in this study.

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All listed authors have significantly contributed to the research, providing direct and intellectual input throughout the process. WAA: Investigation, resources, data curation, writing—original draft. RSA: Investigation, methodology, validation, writing—reviewing and editing. MAA: Validation, writing—reviewing and editing. SMA: Investigation, resources, data curation, writing—original draft. AMA: Investigation, resources, data curation, writing—original draft. SAA: Investigation, resources, data curation, writing—original draft. MSA: Validation, resources, writing—reviewing and editing. ARA: Investigation, methodology, validation, formal analysis, data curation, software, writing—reviewing and editing, supervision. WAA: Investigation, resources, data curation. OMA: Investigation, methodology, validation, writing—reviewing and editing. MSB: Investigation, data curation, writing—reviewing and editing OAA: Validation, methodology, validation, supervision, writing—reviewing and editing.

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Alshahrani, W.A., Alshahrani, R.S., Alkathiri, M.A. et al. Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin in Patients with Venous Thromboembolism using Real-World Data: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs (2024). https://doi.org/10.1007/s40256-024-00677-x

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