Effectiveness and safety of rivaroxaban vs warfarin in patients with pulmonary embolism and right ventricular dysfunction: a retrospective cohort study
Research and Practice in Thrombosis and Haemostasis, 2025
Among patients with pulmonary embolism (PE, also known as blood clots in the lungs), right ventricular dysfunction (RVD) is a common complication. Patients with PE and RVD have a higher risk of adverse outcomes, including a significantly higher risk of venous thromboembolism (VTE, also known as blood clots in veins) recurrence and major bleeding, as compared to those with PE alone. To reduce the risk of VTE for patients with PE, oral anticoagulants such as rivaroxaban and warfarin are frequently prescribed. However, evidence comparing the effects of these treatments on patients with concurrent PE and RVD is limited, partly due to the lack of specific diagnosis codes for RVD in health care data.
To meet this research need, an Analysis Group team – led by Principal François Laliberté, Vice President Guillaume Germain, and Manager Sean MacKnight – collaborated with Shawn Murphy and Yichuan G. Hsieh from Mass General Brigham; Behnood Bikdeli and Gregory Piazza from Brigham and Women’s Hospital; and Veronica Ashton, Brahim Bookhart, and Dereck Wentworth from Johnson & Johnson on a first-of-its-kind real-world retrospective study.
The researchers leveraged a natural language processing (NLP) algorithm that incorporated a range of keywords and negation terms to identify patients with RVD from clinical notes in the Mass General Brigham Research Patient Data Registry (RPDR). In addition to unstructured clinical notes, the RPDR database contains structured electronic health record data from more than 7 million patients across eight major health care facilities associated with Harvard Medical School, enabling researchers to compare the effectiveness and safety of rivaroxaban versus warfarin among patients with both PE and evidence of RVD.
In an article on their study, the authors conclude that their findings “contribute to the limited body of evidence on patients with PE and RVD and may help to inform future interventional studies investigating treatments for this understudied population.”
The article, “Effectiveness and safety of rivaroxaban vs warfarin in patients with pulmonary embolism and right ventricular dysfunction: a retrospective cohort study,” was published in Research and Practice in Thrombosis and Haemostasis.
Authors
Laliberté F, Bikedeli B, Ashton V, Germain G, Boudreau J, Sundar M, MacKnight SD, Bookhart B, Wentworth D, Murphy S, Hsieh YG, Piazza G