Rivaroxaban reduces recurrent VTE among patients with obesity
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Rivaroxaban reduced risk for recurrent venous thromboembolism compared with warfarin among patients with VTE and obesity, according to study results presented during International Society on Thrombosis and Haemostasis 2020 Virtual Congress.
Results of the study, published simultaneously in Journal of Thrombosis and Thrombolysis, also showed no significant differences in major bleeding with rivaroxaban (Xarelto, Janssen).
“Various studies have compared non-vitamin K oral anticoagulants to warfarin in obese patients for management of VTE. However, these studies have been limited by utilization of billing codes, restriction to only morbidly obese patients or a relatively small sample size,” Olivia S. Costa, PharmD, BCPS, researcher in the department of health outcomes at University of Connecticut School of Pharmacy, told Healio.
“Our study aimed to overcome these limitations by using real-world patient-level body mass index data allowing us to look at a range of values in over 13,000 individuals.”
Researchers used electronic health record data to assess the safety and efficacy of rivaroxaban (n = 6,755) compared with warfarin (n = 6,755) for prevention of recurrent VTE among patients with obesity.
All patients had a BMI of 30 kg/m2 or greater and were admitted to the hospital, ED or observation unit for incident VTE. Rivaroxaban or warfarin were prescribed as a first oral anticoagulant within 7 days of being admitted.
VTE risk appeared lowest with rivaroxaban compared with warfarin at 3 months (HR = 0.61; 95% CI, 0.51-0.72), 6 months (HR = 0.65; 95% CI, 0.55-0.77) and 12 months (HR = 0.63; 95% CI, 0.54-0.74).
Researchers observed no differences in major bleeding between the two groups at 3 months (HR = 0.99; 95% CI, 0.68-1.44), 6 months (HR = 0.9; 95% CI, 0.64-1.26) and 12 months (HR = 1; 95% CI, 0.73-1.36).
Results of subanalyses showed no statistically significant interaction across BMI categories for recurrent VTE or major bleeding.
“Rivaroxaban appears to be a reasonable alternative to warfarin in obese patients experiencing VTE to decrease the risk of recurrent VTE without impacting major bleeding,” Costa said. “We plan to continue investigating the outcomes of non-vitamin K oral anticoagulants in high-risk populations. We hope our current and future work will help with decision-making for clinicians.”
For more information:
Olivia S. Costa, PharmD, BCPS, can be reached at University of Connecticut School of Pharmacy, 80 Seymour St., Hartford, CT 06102; email: olivia.costa@hhchealth.org.
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