CC BY-NC-ND 4.0 · Thromb Haemost 2021; 121(03): 383-395
DOI: 10.1055/s-0040-1718728
Stroke, Systemic or Venous Thromboembolism

Effectiveness and Safety of Apixaban, Low-Molecular-Weight Heparin, and Warfarin among Venous Thromboembolism Patients with Active Cancer: A U.S. Claims Data Analysis

Alexander Cohen
1  Department of Hematological Medicine, Guy's & St Thomas' NHS Foundation Trust, King's College London, Westminster Bridge Road, London, United Kingdom
,
Allison Keshishian
2  SIMR, LLC, Ann Arbor, Michigan, United States
,
Theodore Lee
3  Pfizer Inc., New York, New York, United States
,
Gail Wygant
4  Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States
,
Lisa Rosenblatt
4  Bristol-Myers Squibb Company, Lawrenceville, New Jersey, United States
,
Patrick Hlavacek
3  Pfizer Inc., New York, New York, United States
,
Jack Mardekian
3  Pfizer Inc., New York, New York, United States
,
Daniel Wiederkehr
3  Pfizer Inc., New York, New York, United States
,
Janvi Sah
2  SIMR, LLC, Ann Arbor, Michigan, United States
,
Xuemei Luo
5  Pfizer Inc., Groton, Connecticut, United States
› Author Affiliations
Funding This research was funded by Pfizer Inc. and Bristol-Myers Squibb Company.

Abstract

Background This study primarily evaluates the risk of recurrent venous thromboembolism (VTE) and major bleeding (MB) among patients with VTE and active cancer prescribed apixaban, low-molecular-weight heparin (LMWH), or warfarin, with claims data.

Methods Four U.S. commercial insurance claims databases were used to identify patients with VTE and active cancer who initiated apixaban, LMWH, or warfarin within 30 days following the first VTE event. Stabilized inverse-probability treatment weighting (IPTW) was used to balance treatment cohorts. Cox proportional hazard models were used to evaluate risk of recurrent VTE and MB.

Results All eligibility criteria were fulfilled by 3,393 apixaban, 6,108 LMWH, and 4,585 warfarin patients. After IPTW, all patient characteristics were balanced. When the follow-up was censored at 6 months, apixaban patients had a lower risk of recurrent VTE (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47–0.81) and MB (HR: 0.63; 95% CI: 0.47–0.86) versus LMWH. Apixaban patients had a lower risk of recurrent VTE (HR: 0.68; 95% CI: 0.52–0.90) and similar risk of MB (HR: 0.73; 95% CI: 0.53–1.00) versus warfarin. Warfarin patients had a similar risk of recurrent VTE (HR: 0.91; 95% CI: 0.72–1.15) and MB (HR: 0.87; 95% CI: 0.68–1.12) versus LMWH. The trends were similar for the entire follow-up; however, apixaban patients had a lower risk of MB versus warfarin patients.

Conclusion Patients with VTE and active cancer who initiated apixaban had a lower risk of recurrent VTE and MB compared with LMWH patients. Apixaban patients also had a lower risk of recurrent VTE compared with warfarin patients.

Supplementary Material



Publication History

Received: 04 May 2020

Accepted: 02 September 2020

Publication Date:
10 November 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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