Comparative outcomes of apixaban and rivaroxaban in colon cancer patients with venous thromboembolism.

176 Background: Patients with colon cancer complicated by venous thromboembolism (VTE) frequently require anticoagulation. This study aims to directly compare apixaban and rivaroxaban in terms of efficacy and safety profile. Methods: We utilized the TriNetX US Collaborative Network to identify adults with colon cancer and VTE treated with apixaban or rivaroxaban. Propensity score matching generated balanced cohorts (n=5,331 each). Outcomes included mortality, gastrointestinal (GI) bleeding, intracranial bleeding, recurrent pulmonary embolism (PE), deep vein thrombosis (DVT), and stroke. Kaplan–Meier survival analyses, log-rank testing, and hazard ratios (HRs) were used. Results: After matching, mortality was comparable between apixaban and rivaroxaban groups (50.5% vs 52.9%, HR 1.06, 95% CI 0.99–1.13, p=0.076). No significant differences were observed for GI bleeding (HR 0.96, 95% CI 0.87–1.06, p=0.414), intracranial bleeding (HR 1.33, 95% CI 0.91–1.93, p=0.139), or stroke (HR 1.16, 95% CI 0.99–1.36, p=0.066). However, apixaban was associated with a higher risk of recurrent PE (48.7% vs 53.3%, HR 1.18, 95% CI 1.11–1.26, p