Apixaban shows superior effectiveness, safety compared to rivaroxaban

For patients with venous thromboembolism, initiation of apixaban was associated with lower rates of recurrence and intracranial and gastrointestinal bleeding than rivaroxaban in a population-based cohort study.

Patients with venous thromboembolism (VTE) who received apixaban had a lower rate of recurrence, as well as intracranial and gastrointestinal bleeding events, compared with those treated with rivaroxaban, a recent study found.

The retrospective new-user cohort study used a U.S.-based commercial health care insurance database to compare outcomes between patients with VTE who were newly prescribed apixaban or rivaroxaban. The researchers analyzed health records for approximately 37,000 VTE patients who had at least one prescription dispensed for apixaban or rivaroxaban in January 2015 through June 2020. The primary effectiveness outcome was recurrent VTE, a composite of deep venous thrombosis and pulmonary embolism. The primary safety outcome was a composite of gastrointestinal and intracranial bleeding. Results were published Dec. 7 by Annals of Internal Medicine.

Of 49,900 eligible patients with VTE, 18,618 were new users of apixaban and 18,618 were new users of rivaroxaban. Of the patients prescribed apixaban, 475 had recurrent VTE and 386 had gastrointestinal or intracranial bleeding events, while in the rivaroxaban group, 595 had recurrent VTE and 577 had gastrointestinal or intracranial bleeding events. After propensity score matching, apixaban was associated with a lower rate of recurrent VTE (hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.87) and bleeding (HR, 0.60; 95% CI, 0.53 to 0.69). The absolute reduction in the probability of recurrent VTE with apixaban versus rivaroxaban was 0.006 (95% CI, 0.005 to 0.011) within two months of initiation and 0.011 (95% CI, 0.011 to 0.013) within six months of initiation, while the absolute reduction in the probability of gastrointestinal and intracranial bleeding with apixaban versus rivaroxaban at the same time points was 0.011 (95% CI, 0.010 to 0.011) and 0.015 (95% CI, 0.013 to 0.015), respectively.

The study authors acknowledged that limitations included a short follow-up but said their findings suggest that apixaban has superior effectiveness and safety compared with rivaroxaban and may provide guidance to clinicians and patients.

“In the absence of data from [randomized controlled trials], the benefits of apixaban (vs. rivaroxaban) observed in the current study can be used to guide treatment selection in clinical practice along with other factors that may affect treatment choice, including patient preference for once- versus twice-daily dosing, cost, and insurance coverage,” they wrote.