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Comparative effectiveness of oral anticoagulants in venous thromboembolism: GARFIELD-VTE

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  • Henri Bounameaux
  • Sylvia Haas
  • Alfredo E Farjat
  • Walter Ageno
  • Jeffrey I Weitz
  • Samuel Z Goldhaber
  • Alexander G G Turpie
  • Shinya Goto
  • Pantep Angchaisuksiri
  • Joern Dalsgaard Nielsen
  • Gloria Kayani
  • Sebastian Schellong
  • Lorenzo G Mantovani
  • Paolo Prandoni
  • Ajay K Kakkar
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INTRODUCTION: Randomized controlled trials have shown that direct oral anticoagulants (DOACs) are a safe and effective alternative to vitamin K antagonists (VKAs) for the treatment of venous thromboembolism (VTE). However, there are limited post-marketing data describing the effectiveness and safety of the DOACs in the community setting. We aimed to compare the effectiveness of DOACs and VKAs on 12-month outcomes in a real-world VTE patient population.

METHODS: The Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE is an observational study designed to document real-world treatment practices. This intention-to-treat analysis included 7987 VTE patients initiated on either DOACs (N = 4791) or VKAs (N = 3196) with or without pre-treatment with parenteral anticoagulants. Treatment groups were balanced according to baseline characteristics, using overlapping propensity score weights.

RESULTS: After adjustment for baseline characteristics, all-cause mortality was significantly lower with DOAC than with VKAs (hazard ratio [HR]: 0.73; 95% confidence interval [CI] 0.56-0.95. Patients receiving VKAs were more likely than those receiving DOACs to die of complications of VTE (4.7% vs 2.7%) or from bleeding (4.2% vs. 1.3%). There was no significant difference in recurrent VTE (HR: 0.91, 95% CI 0.71-1.18), major bleeding (HR 1.03, 95% CI 0.69-1.54), or overall bleeding (HR 0.96, 95% CI 0.81-1.14) with DOACs or VKAs.

CONCLUSIONS: n this real-world analysis of VTE treatment, DOACs were associated with reduced all-cause mortality compared with VKAs, and similar rates of recurrent VTE and bleeding.

Original languageEnglish
JournalThrombosis Research
Volume191
Pages (from-to)103-112
Number of pages10
ISSN0049-3848
DOIs
Publication statusPublished - Jul 2020

ID: 61765857