Philadelphia—Apixaban and rivaroxaban are commonly used in patients with atrial fibrillation (AF) and valvular heart disease (VHD), but a new study suggested that they are not as interchangeable as some prescribers might believe.
In fact, University of Pennsylvania–led researchers reported that, in a study of patients with AF and VHD, those receiving apixaban had a lower risk for ischemic stroke or systemic embolism and bleeding when compared with those receiving rivaroxaban. VHD is common among patients with AF and increases the risk of death, major adverse cardiovascular events, and major bleeding.
The article in Annals of Internal Medicine describes a new-user, active comparator, cohort study design. The goal was to emulate a target trial of the effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD.
To do that, the researchers used information from a commercial health insurance database from January 1, 2013, and December 31, 2020. The study included new users of apixaban or rivaroxaban who had a diagnosis of AF and VHD before initiation of anticoagulant therapy.
For purposes of the study, the primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. A composite of gastrointestinal or intracranial bleeding was included in the primary safety outcome.
The researchers reported that when compared with rivaroxaban in a propensity score–matched cohort of 19,894 patients (9,947 receiving each drug), apixaban was associated with a lower rate of ischemic stroke or systemic embolism (hazard ratio [HR], 0.57; 95% CI, 0.40-0.80) and bleeding (HR, 0.51 [CI, 0.41 to 0.62]).
“The absolute reduction in the probability of stroke or systemic embolism with apixaban compared with rivaroxaban was 0.0026 within 6 months and 0.011 within 1 year of treatment initiation,” the authors pointed out. “The absolute reduction in the probability of bleeding events with apixaban compared with rivaroxaban was 0.012 within 6 months and 0.019 within 1 year of treatment initiation.”
The researchers suggested that their findings were limited by short follow-up time and their inability to ascertain some types of VHD.
Still, they concluded, “In this study of patients with AF and VHD, patients receiving apixaban had a lower risk for ischemic stroke or systemic embolism and bleeding when compared with those receiving rivaroxaban.”
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