Apixaban prevents gastrointestinal bleeding in patients with atrial fibrillation

Use of apixaban in patients with atrial fibrillation (AF) helps reduce the risk of gastrointestinal bleeding (GIB), results of a study have shown.

Apixaban therapy is also associated with similar rates of ischaemic stroke or systemic embolism, intracranial haemorrhage (ICH), and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban.

“This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials,” the investigators said.

In this multinational population-based cohort study, five standardized electronic healthcare databases, covering 221 million people in France, Germany, UK, and US, were searched to identify patients who were newly diagnosed with AF from 2010 through 2019 and received a new prescription of direct oral anticoagulants (DOACs).

The investigators used a Cox regression model to estimate database-specific hazard ratios (HRs) of ischaemic stroke or systemic embolism, ICH, GIB, and all-cause mortality between DOACs. Findings were stratified by propensity score and pooled using a random-effects model.

Overall, 527,226 new DOAC users were included in the analysis (apixaban: n=281,320; dabigatran: n=61,008; edoxaban: n=12,722; and rivaroxaban: n=172,176).

Use of apixaban correlated with a lower GIB risk compared with the use of dabigatran (HR, 0.81, 95 percent confidence interval [CI], 0.70‒0.94), edoxaban (HR, 0.77, 95 percent CI, 0.66‒0.91), or rivaroxaban (HR, 0.72, 95 percent CI, 0.66‒0.79).

These findings persisted for patients aged at least 80 years, and no significant differences were seen for other outcomes or DOAC-to-DOAC comparisons.

The association between reduced GIB risk and apixaban compared with rivaroxaban was consistent among patients receiving standard dose (HR, 0.72, 95 percent CI, 0.64‒0.82), those receiving a reduced dose (HR, 0.68, 95 percent CI, 0.61‒0.77), and those with chronic kidney disease (HR, 0.68, 95 percent CI, 0.59‒0.77).

“Current guidelines recommend using DOACs over warfarin in patients with AF,” the investigators said.