Comparative effectiveness and safety of apixaban vs. rivaroxaban in patients with cirrhosis and portal vein thrombosis
Lucy S. Wang, Adam Cuker, K. Rajender Reddy, Ghadeer K. DawwasBackground
Portal vein thrombosis (PVT) occurs in ~14% of patients with cirrhosis. Although apixaban and rivaroxaban are increasingly used in this population, comparative data are lacking.
Methods
We conducted a retrospective cohort study of adults with cirrhosis and PVT initiating apixaban or rivaroxaban. Propensity score matching (3 : 1) was used to balance baseline characteristics. The effectiveness outcome was a composite of hepatic decompensation or recurrent PVT and the safety outcome was a composite of gastrointestinal or intracranial bleeding. Cox proportional hazard models estimated hazard ratios (HRs).
Results
After matching, 312 patients were included (206 apixaban, 106 rivaroxaban). Use of apixaban (vs. rivaroxaban) was associated with similar effectiveness [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.50–2.06] and lower risk of bleeding (HR 0.62, 95% CI 0.19–2.12), although CI crossed the null value of 1.
Conclusions
In this real-world cohort, apixaban and rivaroxaban demonstrated comparable effectiveness, with possible lower bleeding risk with apixaban.