Apixaban better than rivaroxaban for AF patients with valvular heart disease: study

Most important findings from this study are:

1. The use of apixaban was associated with a 43% lower risk of ischemic stroke or systemic embolism.

2. Separately, apixaban was associated with a 42% lower risk of ischemic stroke, but the reduction in systemic embolism was not statistically significant.

3. Apixaban was associated with a 49% lower risk of bleeding including a 49% lower risk of gastrointestinal bleeding.

4. There was a trend toward less intracranial hemorrhage, but it was not statistically significant.

5. There was no difference in all-cause mortality between the two DOACs.

"Until evidence from randomized controlled trials becomes available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AF and valvular heart disease," noted Dawwas.

The new data add to a growing body of evidence showing that apixaban may be a safer alternative to rivaroxaban when used in patients with AF. Researchers Abraham et al, investigated the safety profile of various DOACs and found that apixaban was the safest agent when it came to the risk of gastrointestinal bleeding while rivaroxaban had the least favorable safety profile. An observational study from Iceland confirmed those findings, with researchers reporting that gastrointestinal bleeding was nearly 50% more common with rivaroxaban than with apixaban.

Source: Annals of Internal Medicine: https://doi.org/10.7326/M22-0318