Apixaban outdoes rivaroxaban at preventing VTE, bleeding in adults

Patients with venous thromboembolism (VTE) who are new users of apixaban are less likely to experience recurrent VTE and bleeding than new users of rivaroxaban, a study has shown.

In this retrospective new-user cohort study, the authors assessed the effectiveness and safety of apixaban vs rivaroxaban in adults with VTE using a US-based commercial healthcare insurance database from 1 January 2015 to 30 June 2020.

A total of 49,900 patients with VTE were eligible for analysis. Of these, 18,618 were new users of apixaban and 18,618 were new users of rivaroxaban. Median follow-up was 102 days among apixaban users and 105 days among rivaroxaban users.

After propensity score matching, apixaban correlated with a lower rate for recurrent VTE (hazard ratio [HR], 0.77, 95 percent confidence interval [CI], 0.69–0.87) and bleeding (HR, 0.60, 95 percent CI, 0.53–0.69) relative to rivaroxaban.

The absolute reduction in the probability of recurrent VTE with apixaban vs rivaroxaban was 0.006 (95 percent CI, 0.005–0.011) within 2 months and 0.011 (95 percent CI, 0.011–0.013) within 6 months of initiation. For gastrointestinal and intracranial bleeding, absolute reductions were 0.011 (95 percent CI, 0.010–0.011) and 0.015 (95 percent CI, 0.013–0.015) within 2 and 6 months of initiation, respectively.

Of note, the study was limited by its short follow-up.

“Apixaban and rivaroxaban are replacing vitamin K antagonists for the treatment of VTE in adults,” the authors said.