Real-World Effectiveness and Safety of Apixaban versus Warfarin in Patients with Acute Venous Thromboembolism: Experience of a Large Tertiary Hospital in Saudi Arabia

Majed S Al Yami; Mohammed Y Alzahrani; Abdulmajeed M Alshehri; Omar A Alshaya; Norah S Alsubiae; Yazeed M Alharbi; Latifah K Albaiahy; Mounira Aldeiban; Haya A Alkuait; Wejdan Alobaidi; Anas Aldawsari; Nouf M Almutairi; Mohannad Alshibani; Ghazwa B Korayem; Osamah M Alfayez; Abdulaali R Almutairi; Omar A Almohammed

doi:10.2147/IJGM.S322221

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 Jul 28:14:4031-4037. doi: 10.2147/IJGM.S322221. eCollection 2021.

Authors

Majed S Al Yami^{1

2}, Mohammed Y Alzahrani^{1

2}, Abdulmajeed M Alshehri^{1

2}, Omar A Alshaya^{1

2}, Norah S Alsubiae¹, Yazeed M Alharbi¹, Latifah K Albaiahy¹, Mounira Aldeiban¹, Haya A Alkuait³, Wejdan Alobaidi⁴, Anas Aldawsari⁵, Nouf M Almutairi⁶, Mohannad Alshibani⁷, Ghazwa B Korayem⁸, Osamah M Alfayez⁹, Abdulaali R Almutairi¹⁰, Omar A Almohammed¹¹

Affiliations

¹ Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
² King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
³ Sales Department, SPIMACO Addwaeih, Riyadh, Saudi Arabia.
⁴ Sales Department,Novo Nordisk, Riyadh, Saudi Arabia.
⁵ Sales Department,Sanofi, Riyadh, Saudi Arabia.
⁶ Sales Department, BAYER Pharmaceutical, Riyadh, Saudi Arabia.
⁷ Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
⁸ Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
⁹ Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.
¹⁰ Drug Sector, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
¹¹ Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.

Abstract

Purpose: The main objective of this study was to evaluate the effectiveness and safety of apixaban versus warfarin in patients with venous thromboembolism (VTE) in a "real-world" setting.

Patients and methods: A retrospective cohort study was conducted using data from a large tertiary hospital in Saudi Arabia. Patients were included if they were adults (≥18 years), diagnosed with VTE, and treated with either apixaban or warfarin between January 2016 and September 2018. Patients who had received anticoagulation therapy within three months of the date of the index event were excluded. The effectiveness outcomes were incidence of VTE recurrence (ie, deep vein thrombosis DVT or pulmonary embolism [PE]), while the safety outcome was incidence of any major bleeding (MB) event within 90 days of follow-up.

Results: Among the 492 patients included for study, 212 (43.1%) received apixaban and 280 (56.1%) received warfarin. The mean age of patients was 53.6±19.1 years and 62% of the cohort was female. Comparable rates of VTE recurrence were observed for apixaban and warfarin treatment groups during follow-up (adjusted odds ratio (AOR) =0.95; 95% CI 0.53-1.68), including DVT (AOR=1.06; 95% CI 0.52-2.17) and PE (AOR=0.78; 95% CI 0.31-1.96). However, apixaban was associated with significantly fewer MB events than warfarin (AOR=0.18; 95% CI 0.04-0.83).

Conclusion: The use of apixaban for the treatment of Saudi patients with acute VTE is associated with a VTE recurrence rate comparable to that of warfarin, with significantly fewer MB events.

Keywords: DOACs; DVT; PE; VTE; apixaban; bleeding; venous thromboembolism; warfarin.

Grants and funding

The author (OAA) received a fund from the Researcher Supporting Project (RSP-2021/77), King Saud University, Riyadh, Saudi Arabia, to support the publication of this article and the authors would like to extend their appreciation to King Saud University for funding the publication of this work. The funding agency had no role in designing the study, conducting the analysis, interpreting the data or writing the manuscript.