Evaluation of six-month clinical outcomes of patients with venous thromboembolism treated with apixaban, rivaroxaban, edoxaban or dabigatran

Abdulkadir Yilmaz, Dogan Emre Sert, Sinan Sabit Kocabeyoglu, Emrah Uguz, Enis Burak Gül, Bekir Boğaçhan Akkaya, Umit Kervan, Zeki Catav

Abstract

Background: The advantages of direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) over warfarin and low molecular weight heparin have been demonstrated in many studies in the treatment of patients with acute venous thromboembolism (VTE). However, a single-centre study comparing the effectiveness and safety of oral anticoagulants against each other has not yet been conducted.
Aim: The study aimed to compare the results of the efficacy and safety profiles of direct oral anticoagulants (DOACs). The purpose of this study was to compare the effectiveness and safety profiles of DOACs.
Method: The study included 192 patients diagnosed with VTE in Ankara City Hospital between 2019 and 2022. Patients diagnosed with deep vein thrombosis by venous Doppler ultrasonography and those diagnosed with pulmonary embolism by pulmonary computed tomography angiography (CTA) were included in the study. The patients who received regular treatment for six months and came to their controls regularly were analysed. During the six months, control venous Doppler ultrasonography or pulmonary CTA was performed in all patients with symptoms or examination findings suspicious of VTE. Relevant blood values of patients with hepatic or renal dysfunction were observed at the beginning of the treatment. The primary endpoints were recurrent VTE, mortality, and major bleeding events.
Results: The 192 patients included in the study were divided into four groups, with at least 45 patients in each drug group. There was no significant difference between the groups regarding gender, age, weight, comorbidity, rate of provoked VTE, and kidney and liver function tests. 90.6% of the patients had isolated deep venous thrombosis. There was a provoking reason in 49.5%. Obesity and immobilisation were the most frequent provoking causes. During the six-month treatment period, recurrent VTE was observed in three patients, major bleeding in two patients, and death in four patients. Non-major bleeding was seen in 40 patients. There was no significant difference between the four drug groups regarding efficacy and safety.
Conclusion: Our study is essential in comparing the efficacy and safety of four direct oral anticoagulant drugs. Our findings supported that dabigatran, apixaban, edoxaban, and rivaroxaban treatments can be used safely and effectively in the treatment of acute VTE. While high efficacy was achieved with all drugs, a low rate of side effects was observed.