Elderly people recovering from serious blood clots often face long hospitalizations and rehabilitation due to high recurrence rates. But new research suggests that the choice of blood thinner can affect how well patients recover and how much time they spend at home when treating venous thromboembolism. Venous thromboembolism includes deep vein thrombosis, which is a blood clot that usually forms in the legs, and pulmonary embolism, which is a blood clot that travels to the lungs.
Venous thromboembolism is a major health concern for older adults. It is more common in older people and is associated with severe complications and increased mortality. The risk of blood clot recurrence after the initial event remains high, and many patients require long-term anticoagulation therapy to prevent recurrence.
The study, “Comparison of oral anticoagulant efficacy and home time after venous thromboembolism in frail and non-frail elderly people,” American Journal of Hematology. Researchers analyzed Medicare claims data from 2015 to 2019 for patients treated with any of three oral anticoagulants commonly prescribed after acute blood clots: apixaban, rivaroxaban, and warfarin.
Researchers led by a team at Hebrew Senior Life’s Hinda and Arthur Marcus Institute on Aging surveyed more than 18,000 Medicare beneficiaries and found that patients treated with the anticoagulant apixaban (Eliquis) for dangerous blood clots experienced fewer serious complications and spent more days at home rather than in a hospital or nursing home than those treated with warfarin (Coumadin or Jantoven). This result was observed in both frail and non-frail older adults, with the clearest benefit seen in non-frail patients.
Compared with warfarin, apixaban was associated with a lower overall risk of recurrent blood clots or death within 1 year, and a lower rate of major bleeding. Patients taking apixaban also had fewer days of “home time lost.” This is a measure of time lost due to time spent in hospitals, emergency departments, skilled nursing facilities, or death within 365 days if continuously enrolled in Medicare. In contrast, rivaroxaban showed no clear advantage over warfarin in preventing complications and had greater loss of home time than apixaban.
Importantly, this study examined outcomes separately for frail and non-frail older adults, who are often underrepresented in clinical trials. Frailty, a condition characterized by decreased physical resilience and increased vulnerability to disease, can affect both how drugs are processed in the body and the risk of bleeding and other complications. By combining measures of frailty with both clinical outcomes and patient-centered measures such as time spent at home, the researchers aimed to provide real-world evidence to guide treatment decisions for older adults with blood clots.
Elderly people with blood clots often face complex treatment decisions, especially when associated with frailty. Our findings suggest that apixaban may offer a favorable balance of efficacy, safety, and the ability for patients to remain at home, an outcome of great importance for older adults and their families. ”
Chanmi Park, MD, MPH, study lead author and Marcus Institute Scientific Assistant II
Researchers say the findings add important evidence to help clinicians and patients choose among available anticoagulant therapies, especially for older adults whose treatment goals include maintaining independence and minimizing time spent in hospitals or nursing homes.
In addition to Park, researchers included Sandra See, MD, MPH, Assistant Scientist II, of the Marcus Institute; Dr. Xiecheng Chen, Data Scientist I, Marcus Institute. Anna L. Parks, MD, Assistant Professor, Department of Hematology, University of Utah; Daehyun Kim, MD, MPH, ScD, Deputy Director and Senior Scientist, Marcus Institute;
sauce:
Hebrew Senior Life Hinda and Arthur Marcus Institute on Aging
Reference magazines:
Park, CM, others. (2026). Comparison of efficacy of oral anticoagulants and time at home after venous thromboembolism in frail and non-frail elderly. American Journal of Hematology. DOI: 10.1002/ajh.70302. https://onlinelibrary.wiley.com/doi/10.1002/ajh.70302
