Apixaban may be safer, more effective than rivaroxaban for afib

Patients taking rivaroxaban had higher rates of stroke or systemic embolism and gastrointestinal or brain bleeding compared to those taking apixaban, according to a retrospective cohort study.


Apixaban may be safer and more effective than rivaroxaban in preventing strokes and systemic blood clots in patients with atrial fibrillation, a study found.

Researchers used commercial insurance claims data from December 2012 to January 2019 to compare the safety and effectiveness of newly prescribed apixaban and rivaroxaban for patients with nonvalvular atrial fibrillation. Two closely matched treatment groups included 39,351 patients apiece. The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of gastrointestinal bleeding or intracranial hemorrhage. Findings were published March 10 by Annals of Internal Medicine.

The patients' mean age was 69 years and 40% were women. The mean length of follow-up was 288 days for apixaban users and 291 days for rivaroxaban users. The incidence rate of ischemic stroke or systemic embolism was 6.6 per 1,000 person-years with apixaban compared with 8.0 per 1,000 person-years with rivaroxaban (hazard ratio [HR], 0.82 [95% CI, 0.68 to 0.98]; rate difference, 1.4 fewer events per 1,000 person-years [95% CI, 0.0 to 2.7]). Gastrointestinal bleeding or intracranial hemorrhage was also significantly lower with apixaban, at a rate of 12.9 per 1,000 person-years compared to 21.9 per 1,000 person-years for rivaroxaban (HR, 0.58 [95% CI, 0.52 to 0.66]; rate difference, 9.0 fewer events per 1,000 person-years [95% CI, 6.9 to 11.1]).

These results should help to inform discussions of treatment options with patients who have atrial fibrillation, the authors wrote. “Until head-to-head clinical trial data are available, the results of our study, which included a large sample of patients seen in routine care, provides updated evidence in support of apixaban for treating nonvalvular atrial fibrillation,” the authors concluded.