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Clinical Trial
. 2022 Nov;175(11):1506-1514.
doi: 10.7326/M22-0318. Epub 2022 Oct 18.

Apixaban Versus Rivaroxaban in Patients With Atrial Fibrillation and Valvular Heart Disease : A Population-Based Study

Ghadeer K Dawwas  1 , Adam Cuker  2 , Geoffrey D Barnes  3 , James D Lewis  4 , Sean Hennessy  5
Affiliations
Clinical Trial

Apixaban Versus Rivaroxaban in Patients With Atrial Fibrillation and Valvular Heart Disease : A Population-Based Study

Ghadeer K Dawwas et al. Ann Intern Med. 2022 Nov.

Erratum in

Abstract

Background: Although apixaban and rivaroxaban are commonly used in patients with atrial fibrillation (AF) and valvular heart disease (VHD), there is limited evidence comparing the 2 drugs in these patients.

Objective: To emulate a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD.

Design: New-user, active comparator, cohort study design.

Setting: Commercial health insurance database from 1 January 2013 to 31 December 2020.

Patients: New users of apixaban or rivaroxaban who had a diagnosis of AF and VHD before initiation of anticoagulant therapy.

Measurements: The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of gastrointestinal or intracranial bleeding. Cox proportional hazards regression with a robust variance estimator was used to estimate hazard ratios (HRs) and 95% CIs.

Results: When compared with rivaroxaban in a propensity score-matched cohort of 19 894 patients (9947 receiving each drug), apixaban was associated with a lower rate of ischemic stroke or systemic embolism (HR, 0.57 [95% CI, 0.40 to 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 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.

Limitation: Short follow-up time and inability to ascertain some types of VHD.

Conclusion: In this study of patients with AF and VHD, patients receiving apixaban had a lower risk for ischemic stroke or systemic embolism and for bleeding when compared with those receiving rivaroxaban.

Primary funding source: National Institutes of Health.

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Figures

Figure.
Figure.
Flow diagram of the study population. * Categories are not mutually exclusive.
Figure.
Figure.
Cumulative incidence curves depicting the risk for stroke or systemic embolism (top) and bleeding (bottom) in matched cohorts of patients with atrial fibrillation and valvular heart disease who were new users of apixaban or rivaroxaban. Horizontal lines represent the cumulative incidence over follow-up time for apixaban and rivaroxaban. Vertical lines represent the probability of stroke or systemic embolism (top) and bleeding events (bottom) with apixaban compared with rivaroxaban within 6 mo and 1 y of treatment initiation. PR= probability.
See this image and copyright information in PMC

References

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