Apixaban versus rivaroxaban for venous thromboembolism in gastric cancer: Insights from a propensity-matched cohort study.

420 Background: Patients with gastric cancer complicated by venous thromboembolism (VTE) often require anticoagulation. This study aims to compare safety and effectiveness of apixaban versus rivaroxaban in this setting. Methods: Using the TriNetX US Collaborative Network, we identified adults with gastric cancer and VTE who received either apixaban or rivaroxaban. Propensity score matching was applied, yielding two balanced cohorts (n=1,266 each). Outcomes assessed included mortality, gastrointestinal (GI) bleeding, intracranial bleeding, recurrent pulmonary embolism (PE), deep vein thrombosis (DVT), and stroke. Kaplan–Meier survival analyses with log-rank tests and hazard ratios (HRs) were performed. Results: Mortality was similar between apixaban and rivaroxaban groups (33.2% vs 36.4%, HR 1.07, 95% CI 0.96–1.20, p=0.245). Risks of upper/lower GI bleeding (HR 0.93, 95% CI 0.78–1.11, p=0.429), intracranial bleeding (HR 1.49, 95% CI 0.78–2.85, p=0.229), DVT (HR 0.92, 95% CI 0.81–1.06, p=0.257), and stroke (HR 1.13, 95% CI 0.82–1.56, p=0.439) did not differ significantly. However, recurrent PE was more frequent with apixaban (44.6% vs 52.1%, HR 1.19, 95% CI 1.06–1.34, p=0.004). Conclusions: In gastric cancer patients with VTE, apixaban and rivaroxaban demonstrated comparable safety profiles for bleeding and most thrombotic outcomes. Rivaroxaban was associated with a lower risk of recurrent PE, while mortality rates were similar. These findings suggest both agents are reasonable options, though rivaroxaban may offer an advantage in preventing PE recurrence.