On-treatment Comparative Effectiveness of Vitamin K Antagonists and Direct Oral Anticoagulants in GARFIELD-VTE, and Focus on Cancer and Renal Disease

Sylvia Haas*, Alfredo E Farjat, Karen Pieper, Walter Ageno, Pantep Angchaisuksiri, Henri Bounameaux, Samuel Z Goldhaber, Shinya Goto, Lorenzo Mantovani, Paolo Prandoni, Sebastian Schellong, Alexander G G Turpie, Jeffrey I Weitz, Peter MacCallum, Hugo Ten Cate, Elizaveta Panchenko, Marc Carrier, Carlos Jerjes-Sanchez, Harry Gibbs, Petr JanskyGloria Kayani, Ajay K Kakkar, GARFIELD-VTE Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background  Direct oral anticoagulants (DOACs) provide a safe, effective alternative to vitamin K antagonists (VKAs) for venous thromboembolism (VTE) treatment, as shown via intention-to-treat comparative effectiveness analysis. However, on-treatment analysis is imperative in observational studies because anticoagulation choice and duration are at investigators' discretion. Objectives  The aim of the study is to compare the effectiveness of DOACs and VKAs on 12-month outcomes in VTE patients using on-treatment analysis. Methods  The Global Anticoagulant Registry in the FIELD - VTE (GARFIELD-VTE) is a world-wide, prospective, non-interventional study observing treatment of VTE in routine clinical practice. Results  In total, 8,034 patients received VKAs ( n  = 3,043, 37.9%) or DOACs ( n  = 4,991, 62.1%). After adjustment for baseline characteristics and follow-up bleeding events, and accounting for possible time-varying confounding, all-cause mortality was significantly lower with DOACs than VKAs (hazard ratio: 0.58 [95% confidence interval 0.42-0.79]). Furthermore, patients receiving VKAs were more likely to die of VTE complications (4.9 vs. 2.2%) or bleeding (4.9 vs. 0.0%). There was no significant difference in rates of recurrent VTE (hazard ratio: 0.74 [0.55-1.01]), major bleeding (hazard ratio: 0.76 [0.47-1.24]), or overall bleeding (hazard ratio: 0.87 [0.72-1.05]) with DOACs or VKAs. Unadjusted analyses suggested that VKA patients with active cancer or renal insufficiency were more likely to die than patients treated with DOAC (52.51 [37.33-73.86] vs. 26.52 [19.37-36.29] and 9.97 [7.51-13.23] vs. 4.70 [3.25-6.81] per 100 person-years, respectively). Conclusion  DOACs and VKAs had similar rates of recurrent VTE and major bleeding. However, DOACs were associated with reduced all-cause mortality and a lower likelihood of death from VTE or bleeding compared with VKAs.

Original languageEnglish
Pages (from-to)e354-e364
Number of pages11
JournalTH open : companion journal to thrombosis and haemostasis
Issue number4
Publication statusPublished - Oct 2022

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