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Study results show that apixaban (Eliquis; Bristol Myers Squibb and Pfizer) for venous thromboembolism showed a lower risk of recurrent blood clots or death within one year of treatment initiation, when given to older adults.
The direct-acting oral anticoagulant (DOAC) was also associated with lower rates of major bleeding over the same time scale.
Publishing their findings in March 2026 in the American Journal of Hematology, researchers looked at data from 18,066 Medicare users in the United States aged 66 years and older, who had been diagnosed with acute venous thromboembolism (VTE).
Participants had received a prescription for warfarin, rivaroxaban or apixaban between 1 January 2015 and 31 December 2019. Of these, 4,769 (26.4%) used warfarin, 7,158 (39.6%) apixaban and 6,139 (34.0%) rivaroxaban. The cohorts were divided into three groups: total, non-frail and frail.
Compared with warfarin, apixaban was associated with lower rates of recurrent VTE, at 40.5 events versus 54.8 per 1,000 person-years. There was no statistically significant difference in effect when frail patients were compared with non-frail.
Among people taking apixaban, major bleeding occurred at 19.4 per 1,000 person-years compared with 26.0 per 1,000 person-years in those taking warfarin; again with no significant difference between frail and non-frail patients.
Rivaroxaban and warfarin showed similar rates of major bleeding.
The researchers also looked at days spent away from home under medical care, known as ‘home time loss’. People in both the frail and non-frail cohorts taking apixaban experienced an average of 12.1 fewer days of home time loss compared with warfarin (54.9 versus 67.0).
Rivaroxaban was associated with 8% more home time loss compared with apixaban in both frail and non-frail cohorts.
In an accompanying news story, lead author Chanmi Park, assistant scientist at the Marcus Institute for Aging Research in Boston, Massachusetts, said: “Our findings suggest that apixaban may offer a favourable balance of effectiveness, safety and the ability for patients to remain at home, which is an outcome that matters greatly to older adults and their families.”
In March 2026, study results published in the New England Journal of Medicine showed that apixaban showed a reduce rate of major bleeding events compared with rivaroxaban, over a three-month period.
Paul Wright, consultant cardiovascular pharmacist at Barts Health NHS Trust in London, said the study was a “really interesting paper reflecting observational data on real-world use”.
“Over the course of the year in comparison to warfarin, apixaban showed favourable outcomes of efficacy and safety. For those on rivaroxaban we saw similar but not improved outcomes,” he added.
“For VTE treatment, the shorter duration of loading dose and data such as this would support its use as a first line DOAC for VTE treatment.”
Read more: ‘Prescribing dilemma: balancing risk and benefit when prescribing anticoagulation in an older patient with falls risk‘
