Effectiveness and Safety of Rivaroxaban Versus Warfarin in Venous Thromboembolism Patients with Comorbid Obstructive Sleep Apnea: A Retrospective Cohort Study.

IntroductionObstructive sleep apnea (OSA) is prevalent in patients with venous thromboembolism (VTE). We sought to evaluate the effectiveness and safety of rivaroxaban versus warfarin in VTE patients with comorbid OSA.MethodsWe performed retrospective cohort analyses using the Optum® de-identified Electronic Health Record data set (Optum® EHR) from November 1, 2011 to June 30, 2023. We included adults with OSA at baseline who newly initiated rivaroxaban or warfarin for an acute VTE and had ≥12 months of prior EHR activity. Patients who had nonvalvular atrial fibrillation, had a hip/knee replacement ≤35 days before the acute VTE, were pregnant, or had active cancer were excluded. Times to recurrent VTE and major bleeding were evaluated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using propensity score-overlap weighting proportional hazards regression.ResultsA total of 14,215 patients met the study criteria and were included in the analyses (rivaroxaban: 7453; warfarin: 6762). We observed similar risks of recurrent VTE (HR = 1.0, 95% CI: 0.80-1.26) and major bleeding (HR = 0.87, 95% CI: 0.65-1.17) through 12 months with rivaroxaban- compared to warfarin-treated patients.ConclusionFor patients with acute VTE and comorbid OSA, rivaroxaban is as effective as warfarin in preventing recurrent VTE, with a similar risk of major bleeding.