Abstract
Background
The effectiveness of rivaroxaban to reduce post-thrombotic syndrome in patients with
venous thromboembolism is largely unknown. We compared rates of post-thrombotic syndrome
in patients given rivaroxaban versus warfarin in a cohort of patients with incident
venous thromboembolism receiving routine clinical care.
Methods
We linked Danish nationwide registries to identify all patients with incident venous
thromboembolism who were new users of rivaroxaban or warfarin and compared rates of
post-thrombotic syndrome using an inverse probability of treatment-weighting approach
to account for baseline confounding.
Results
We identified 19,957 oral anticoagulation–naive patients with incident venous thromboembolism
treated with warfarin or rivaroxaban (mean age, 64 years; 48% were female, 45.5% had
pulmonary embolism). The propensity-weighted rate of post-thrombotic syndrome at 3
years follow-up was 0.53 incidents per 100 person-years with rivaroxaban versus 0.55
per 100 person-years with warfarin, yielding a hazard rate of 0.88 (95% confidence
interval, 0.66-1.17). This association remained consistent across types of venous
thromboembolism (deep venous thrombosis vs pulmonary embolism, and provoked vs unprovoked
venous thromboembolism) and when censoring patients with recurrent venous thromboembolism.
Conclusions
In this clinical practice setting, rivaroxaban was associated with lower but statistically
nonsignificant rates of post-thrombotic syndrome, which did not appear to be mediated
only by an effect on recurrent venous thromboembolism.
Keywords
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Article info
Publication history
Published online: February 21, 2018
Footnotes
Funding: The Obel Family Foundation partly funded this research by an unrestricted grant. The sponsor had no role the design and conduct of the study; collection, management, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
Conflicts of Interest: TBL has served as an investigator for Janssen Scientific Affairs, LLC, and Boehringer Ingelheim, and has been on the speaker bureaus for Bayer, BMS/Pfizer, Roche Diagnostics, Boehringer Ingelheim, and Takeda Pharma. FS has been a consultant for Bayer. PBN has received speaking fees from Boehringer Ingelheim, consulting fees from Bayer, and grant support from BMS/Pfizer. CIC has received grant funding and consulting fees from Bayer AG, Janssen Pharmaceuticals, and Boehringer Ingelheim Pharmaceuticals.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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