Arrhythmias & electrophysiology
Apixaban vs rivaroxaban in patients with atrial fibrillation at high or low bleeding risk: A population-based cohort study
Authors' conclusion
In older AF patients with high or low bleeding risk, treatment with apixaban was associated with lower rates of major bleeding with no difference in risk for thromboembolic events compared with rivaroxaban.
Study context
- Population
- Adults ≥66 years with atrial fibrillation (AF) treated with apixaban or rivaroxaban, Ontario, Canada, 2011–2020, stratified by bleeding risk (high risk = HAS-BLED ≥3)18,156 high-risk
- Exposure
- Apixaban vs rivaroxaban
- Outcome
- Primary efficacy: thromboembolic events; primary safety: major bleeding
Methodological detailspopulation-based, inverse probability of treatment weighting
- Population-based
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Major bleeding (primary safety) and thromboembolic events (primary efficacy), by HAS-BLED bleeding risk
Apixaban
- Major bleeding, high risk
- 2.9% per year
- Major bleeding, low risk
- 1.8% per year
Rivaroxaban
- Major bleeding, high risk
- 4.2% per year
- Major bleeding, low risk
- 2.9% per year
Major bleeding, high risk
Apixaban2.9% per year
Rivaroxaban4.2% per year
Major bleeding, low risk
Apixaban1.8% per year
Rivaroxaban2.9% per year
Apixaban vs RivaroxabanHazard ratio (95% CI)
Major bleeding, high bleeding risk (HAS-BLED ≥3)
0.69(0.58–0.81)
Major bleeding, low bleeding risk
0.63(0.56–0.70)
HR
- No differences in thromboembolic events, high-risk: 3.1% vs 3.0% per year
- 1.02 (95% CI 0.86-1.22)
- No differences in thromboembolic events, low-risk: 1.9% vs 1.9% per year
- 1.00 (95% CI 0.89-1.14)
Observational data: associations, not effects.
Further findings
Apixaban use, by bleeding risk
- High-risk patients using apixaban
- 63%
- Low-risk patients using apixaban
- 56%
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding (primary safety outcome), by bleeding risk — Apixaban vs Rivaroxaban · high bleeding risk: 2.9% vs 4.2% per year | 0.69 (0.58–0.81) | |
| Major bleeding (primary safety outcome), by bleeding risk — Apixaban vs Rivaroxaban · low bleeding risk: 1.8% vs 2.9% per year | 0.63 (0.56–0.70) | |
| 0.512Hazard ratio (log scale) |
Original publication
Apixaban vs rivaroxaban in patients with atrial fibrillation at high or low bleeding risk: A population-based cohort study. Heart Rhythm. Published 21 August 2024. doi:10.
Summarised from the published abstract; every number is checked against it