The blood thinner apixaban may be safer and more effective than rivaroxaban in preventing strokes and systemic blood clots in patients with atrial fibrillation. Therefore apixaban may be preferable to rivaroxaban in patients with atrial fibrillation, according to the observational study. The findings from the study are published in the Annals of Internal Medicine.
Patients with atrial fibrillation are often prescribed anticoagulants to prevent blood clots or stroke. Apixaban and rivaroxaban are newer blood thinners that are being recommended over warfarin because of their improved safety. Although trials have individually compared apixaban and rivaroxaban with warfarin in patients with atrial fibrillation, few studies have compared the two treatments with each other.
Researchers from Brigham and Women's Hospital and Sinai Health conducted a retrospective cohort study to compare the safety and effectiveness of apixaban versus rivaroxaban for patients with nonvalvular atrial fibrillation. The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of intracranial haemorrhage or gastrointestinal bleeding.
They studied a nationwide U.S. commercial insurance claims database to compare the safety and effectiveness of apixaban versus rivaroxaban for patients newly prescribed one of the blood thinners for nonvalvular atrial fibrillation. Two closely matched treatment groups included 39,351 patients who were prescribed apixaban and 39,351 prescribed rivaroxaban. At 290 days follow-up, the incidence of ischemic stroke or systemic embolism was lower with apixaban than rivaroxaban (6.6 vs. 8.0 per 1000 person-years), as was the incidence of gastrointestinal bleeding or intracranial haemorrhage (12.9 vs. 21.9 per 1000 person-years).
The researchers concluded that In routine care, adults with atrial fibrillation prescribed apixaban had a lower rate of both ischemic stroke or systemic embolism and bleeding compared with that prescribed rivaroxaban. According to the lead author, the results should help to inform decision making when discussing treatment options with patients who have atrial fibrillation.
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http://annals.org/aim/article/doi/10.7326/M19-2522