Apixaban better than rivaroxaban in routine care of patients with atrial fibrillation

Incidence of ischaemic stroke or systemic embolism is lower in adults with atrial fibrillation treated with apixaban than those prescribed rivaroxaban, results of a recent study have shown.

Adults who were newly prescribed apixaban (n=59,172) or rivaroxaban (n=40,706) were included in this new-user, active-comparator, retrospective study. Participants were identified form a US nationwide commercial healthcare claims database from 28 December 2012 to 1 January 2019.

Of these new users (mean age, 69 years; 40 percent women), 39,351 on apixaban were propensity-score matched to 39,351 on rivaroxaban. Mean follow-up was 288 days for apixaban users and 291 days for rivaroxaban users.

The incidence rate of ischaemic stroke or systemic embolism was lower among apixaban users than rivaroxaban users (6.6 vs 8.8 per 1,000 person-years; hazard ratio [HR], 0.82, 95 percent confidence interval, 0.68–0.98; rate difference, 1.4 fewer events per 1,000 person-years, 95 percent CI, 0.0–2.7).

In addition, the rate of gastrointestinal bleeding or intracranial haemorrhage was lower among patients prescribed apixaban than rivaroxaban (12.9 vs 21.9 per 1,000 person-years; HR, 0.58, 95 percent CI, 0.52–0.66; rate difference, 9.0 fewer events per 1,000 person-years, 95 percent CI, 6.9–11.1).

“Apixaban and rivaroxaban are the most commonly prescribed direct oral anticoagulants for adults with atrial fibrillation, but head-to-head data comparing their safety and effectiveness are lacking,” the authors noted.

The study was limited by unmeasured confounding and incomplete laboratory data, they added.