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Meta-Analysis
. 2019 Aug 13;3(15):2381-2387.
doi: 10.1182/bloodadvances.2019000572.

Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world

Madan Raj Aryal  1 , Rohit Gosain  1 , Anthony Donato  2 , Han Yu  3 , Anjan Katel  4 , Yashoda Bhandari  5 , Rashmi Dhital  2 , Peter A Kouides  6
Affiliations
Meta-Analysis

Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world

Madan Raj Aryal et al. Blood Adv. .

Abstract

Both apixaban and rivaroxaban have been approved for use in acute venous thromboembolism (VTE). Although indirect comparison through network meta-analyses of randomized trials have been performed to compare the efficacy and safety of these agents, further comparison between these agents was lacking until recently. We sought to systematically review and carry out a meta-analysis of studies to further compare apixaban with rivaroxaban from multiple studies done in the real-world settings. Studies comparing rivaroxaban with apixaban in patients with acute VTE were identified through electronic literature searches of MEDLINE, EMBASE, Scopus, and the Cochrane library up to May 2019. Study-specific risk ratios (RRs) were calculated and combined using a random-effects model meta-analysis. In an analysis involving 24 041 patients, recurrent VTE within 6 months occurred in 56 of 4897 patients (1.14%) in the apixaban group and 258 of 19 144 patients (1.35%) in the rivaroxaban group (RR, 0.89; 95% confidence interval [CI], 0.67-1.19; P = .45). Clinically relevant major bleeding occurred in 85 of 11 559 patients (0.74%) in the apixaban group and 350 of 33 909 patients (1.03%) in the rivaroxaban group (RR, 0.73; 95% CI, 0.58-0.93; P = .01). Clinically relevant nonmajor bleeding occurred in 169 of 3417 patients (4.95%) in the apixaban group and 1094 of 12 475 patients (8.77%) in the rivaroxaban group (RR, 0.59; 95% CI, 0.50-0.70; P < .01). Apixaban shows equivalent efficacy in prevention of recurrent VTE but decreased risk of major and minor bleeding events compared with rivaroxaban.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Flow chart describing systematic research search and study selection process.
Figure 2.
Figure 2.
VTE events.
Figure 3.
Figure 3.
Major bleeding events.
Figure 4.
Figure 4.
Clinically relevant nonmajor bleeding.
See this image and copyright information in PMC

References

    1. Kearon C, Akl EA, Ornelas J, et al. . Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [published correction appears in Chest. 2016;150(4):988]. Chest. 2016;149(2):315-352. - PubMed
    1. Lippi G, Mattiuzzi C, Cervellin G, Favaloro EJ. Direct oral anticoagulants: analysis of worldwide use and popularity using Google trends. Ann Transl Med. 2017;5(16):322. - PMC - PubMed
    1. Barnes GD, Lucas E, Alexander GC, Goldberger ZD. National trends in ambulatory oral anticoagulant use. Am J Med. 2015;128(12):1300-1305.e2. - PMC - PubMed
    1. Cohen AT, Hill NR, Luo X, Masseria C, Abariga SA, Ashaye AO. A systematic review of network meta-analyses among patients with nonvalvular atrial fibrillation: a comparison of efficacy and safety following treatment with direct oral anticoagulants. Int J Cardiol. 2018;269:174-181. - PubMed
    1. Mitchell SA, Simon TA, Raza S, et al. . The efficacy and safety of oral anticoagulants in warfarin-suitable patients with nonvalvular atrial fibrillation: systematic review and meta-analysis. Clin Appl Thromb Hemost. 2013;19(6):619-631. - PubMed

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