Safety of Direct-Acting Oral Anticoagulants vs. Warfarin for Venous Thromboembolism

Are direct-acting oral anticoagulants (DOACs) as safe as warfarin for treating patients with venous thromboembolism (VTE; i.e., deep venous thrombosis and pulmonary embolism)? In this multicenter, retrospective cohort study, researchers used community-based healthcare data from Canada and the U.S. to match 12,500 patients with incident VTE and new prescriptions for DOACs (mostly rivaroxaban [Xarelto]) within 30 days of VTE diagnoses with 47,000 patients with incident VTE and new warfarin prescriptions.

During mean follow-up of 85 days, 3.3% of participants experienced major bleeding (i.e., first hospital admissions or emergency department visits for intracranial, gastrointestinal, or other bleeding) within 90 days of prescription receipt, and about 1.7% died. Risk for major bleeding and death from all causes did not differ significantly between DOAC users and warfarin users. No heterogeneity was found in risk for bleeding or all-cause death associated with DOAC use when patients were assessed according to chronic kidney disease status.