Apixaban safer, more effective than rivaroxaban for afib with heart disease, study finds
Apixaban was associated with a lower rate of ischemic stroke or systemic embolism and a lower rate of bleeding in a propensity-matched cohort study of commercially insured patients with atrial fibrillation (AF) and valvular heart disease.
A large population-based study of patients with atrial fibrillation (AF) and valvular heart disease found that use of apixaban was associated with lower rates ischemic stroke, systemic embolism, and bleeding compared with rivaroxaban.
Researchers studied data from a large commercial health insurance database from January 2013 to December 2020 to emulate a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and valvular heart disease. Of the 33,907 patients included in the study, 23,712 took apixaban for the first time and 10,195 were treated with rivaroxaban. The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of GI or intracranial bleeding. The study was published Oct. 18 by Annals of Internal Medicine.
In a propensity score-matched cohort of 19,894 patients (9,947 receiving each drug), the incidence of ischemic stroke or systemic embolism per 1,000 person-years of follow-up was 5.2 among apixaban users and 9.1 among rivaroxaban users. The incidence rate of GI or intracranial bleeding per 1,000 person-years of follow-up was 14.3 among apixaban users and 28.1 among rivaroxaban users. These differences resulted in significantly lower hazard ratios for apixaban on each outcome: 0.57 (95% CI, 0.40 to 0.80) for ischemic stroke or systemic embolism and 0.51 (95% CI, 0.41 to 0.62) for bleeding. There was no statistically significant difference in all-cause mortality between the two groups.
The absolute reduction in the probability of stroke or systemic embolism with apixaban compared with rivaroxaban was 0.0026 within six months and 0.011 within one year of starting treatment, the study authors calculated. The absolute reduction in the probability of bleeding events with apixaban compared with rivaroxaban was 0.012 within six months and 0.019 within one year of starting treatment.
Since there are no direct, randomized comparisons of apixaban and rivaroxaban in patients with both AF and valvular heart disease, these findings have important clinical implications for patients and physicians, the study authors said. “Until evidence from randomized controlled trials become available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AF and [valvular heart disease],” they wrote.