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The most widely prescribed direct-acting oral anticoagulants in the U.S., apixaban and rivaroxaban, have not been compared head-to-head in randomized trials. In this observational study of consecutive patients from a Mayo Clinic thrombophilia clinic, researchers compared outcomes in 302 patients who received apixaban and 298 who received rivaroxaban to treat acute venous thromboembolism (VTE) for a minimum of 3 months (median, ≈4 months). About 20% of patients had unprovoked VTE, about 40% had active cancer, and nearly all had creatinine clearance >50 mL/minute. Analyses were adjusted for modest baseline differences between the two groups.
Rates of both recurrent VTE and major bleeding were slightly (but not statistically significantly) high…