Comparative outcomes of apixaban and rivaroxaban in colon cancer patients with venous thromboembolism.

Abstract

176 Background: Patients with colon cancer complicated by venous thromboembolism (VTE) frequently require anticoagulation. This study aims to directly compare apixaban and rivaroxaban in terms of efficacy and safety profile. Methods: We utilized the TriNetX US Collaborative Network to identify adults with colon cancer and VTE treated with apixaban or rivaroxaban. Propensity score matching generated balanced cohorts (n=5,331 each). Outcomes included mortality, gastrointestinal (GI) bleeding, intracranial bleeding, recurrent pulmonary embolism (PE), deep vein thrombosis (DVT), and stroke. Kaplan–Meier survival analyses, log-rank testing, and hazard ratios (HRs) were used. Results: After matching, mortality was comparable between apixaban and rivaroxaban groups (50.5% vs 52.9%, HR 1.06, 95% CI 0.99–1.13, p=0.076). No significant differences were observed for GI bleeding (HR 0.96, 95% CI 0.87–1.06, p=0.414), intracranial bleeding (HR 1.33, 95% CI 0.91–1.93, p=0.139), or stroke (HR 1.16, 95% CI 0.99–1.36, p=0.066). However, apixaban was associated with a higher risk of recurrent PE (48.7% vs 53.3%, HR 1.18, 95% CI 1.11–1.26, p<0.001), whereas rivaroxaban was associated with a higher risk of recurrent DVT (58.6% vs 57.4%, HR 0.93, 95% CI 0.87–0.99, p=0.022). Conclusions: In colon cancer patients with VTE, apixaban and rivaroxaban demonstrated similar mortality and bleeding outcomes. Differences were observed in thrombotic events, with rivaroxaban reducing PE recurrence but showing slightly higher rates of DVT. These findings highlight the need for individualized anticoagulant selection in this high-risk population.