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New research · Internal Medicine
Journal of clinical medicine · 2h
Cohort studyJournal of clinical medicine · 2026

Comparison of the Safety and Effectiveness of Apixaban Versus Rivaroxaban in Acute Venous Thromboembolism: A Propensity-Matched Real-World TriNetX Study with Obesity and Cancer Subgroup Analyses.

Faizan Ahmed, Saifullah Khan, Madeeha Shafqat … Mohammad Amir Hossain
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Internal MedicineCohort study

Apixaban linked to higher 2-year all-cause mortality than rivaroxaban after venous thromboembolism

Comparison of the Safety and Effectiveness of Apixaban Versus Rivaroxaban in Acute Venous Thromboembolism: A Propensity-Matched Real-World TriNetX Study with Obesity and Cancer Subgroup Analyses.

Faizan Ahmed … Mohammad Amir Hossain
Journal of clinical medicine · 2026
Background

Apixaban and rivaroxaban are commonly used direct oral anticoagulants for venous thromboembolism (venous thromboembolism), but comparative real-world effectiveness and safety data remain limited.

Methods

We conducted a retrospective cohort study using the TriNetX database.

Results

apixaban linked to higher risk of death by 2 years

HR by subgroup · 95% CI
null = 1
broadly comparable at 3 months
1.02
apixaban at 6-month
1.07
1-year
1.07
2-year follow-ups
1.08
at the 2-year follow-up for apixaban
1.20
More results

A statistically significant reduction in non-major bleeding with regard to apixaban was observed at the 6-month follow-up only (HR 0.79, 95% CI 0.63-0.98; p = 0.033) (2-year ARD: -0.004, 95% CI: -0.010-0.002).

“
Conclusion · 1 of 2

In this real-world propensity-matched analysis, apixaban and rivaroxaban demonstrated broadly comparable effectiveness and safety for venous thromboembolism treatment, with largely similar bleeding outcomes in the overall cohort.

Conclusion · 2 of 2

Small but statistically significant increases in recurrent venous thromboembolism and 2-year mortality with apixaban, alongside subgroup-specific bleeding differences, underscore the importance of individualized treatment selection based on patient-specific risk factors.

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