Arrhythmias & electrophysiology
Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation
An erratum to this article was published (JAMA, 5 Apr 2022 ↗)
Authors' conclusion
Among Medicare beneficiaries 65 years or older with atrial fibrillation, treatment with rivaroxaban compared with apixaban was associated with a significantly increased risk of major ischemic or hemorrhagic events.
Study context
- Population
- US Medicare beneficiaries ≥65 years with AF starting rivaroxaban or apixaban, 2013–2018
- Participants
- 581,451 beneficiaries474,605 person-years
- Exposure
- Rivaroxaban vs apixaban
- Rivaroxabann = 227,572
- Apixabann = 353,879reference
- Outcome
- Composite of:
- Major ischemic (stroke/systemic embolism)
- Hemorrhagic (intracerebral hemorrhage/other intracranial bleeding/fatal extracranial bleeding) events
Methodological detailsinverse probability of treatment weighting
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Rivaroxaban
16.1 per 1000 person-years
Apixaban
13.4 per 1000 person-years
Each group vs apixabanRD, per 1000 person-years (95% CI)
Rivaroxaban
2.7(1.9–3.5)
Each group vs apixabanHazard ratio (95% CI)
Rivaroxaban
1.18(1.12–1.24)
Observational data: associations, not effects.
Secondary outcomes
Per 1000 person-years
| Outcome | Rivaroxaban | Apixaban | RD (95% CI) | |
|---|---|---|---|---|
| Major ischemic events | 8.6 | 7.6 | 1.1 (0.5–1.7) | |
| Fatal ischemic/hemorrhagic events | 4.5 | 3.3 | 1.2 (0.8–1.6) | |
| Total mortality | 44.2 | 41.0 | 3.1 (1.8–4.5) | |
| Primary outcome, reduced dose (subgroup) | 27.4 | 21.0 | 6.4 (4.1–8.7) | |
| Primary outcome, standard dose (subgroup) | 13.2 | 11.4 | 1.8 (1.0–2.6) | |
| −50510Difference (linear scale) |
| Outcome | HR (95% CI) | |
|---|---|---|
| Major ischemic events | 1.12 (1.04–1.20) | |
| Fatal ischemic/hemorrhagic events | 1.34 (1.21–1.48) | |
| Total mortality | 1.06 (1.02–1.09) | |
| Primary outcome, reduced dose (subgroup) | 1.28 (1.16–1.40) | |
| Primary outcome, standard dose (subgroup) | 1.13 (1.06–1.21) | |
| 0.512Hazard ratio (log scale) |
Safety
Per 1000 person-years
| Outcome | Rivaroxaban | Apixaban | RD (95% CI) | |
|---|---|---|---|---|
| Major hemorrhagic events | 7.5 | 5.9 | 1.6 (1.1–2.1) | |
| Fatal extracranial bleeding | 1.4 | 1.0 | 0.4 (0.2–0.7) | |
| Nonfatal extracranial bleeding | 39.7 | 18.5 | 21.1 (20.0–22.3) | |
| −100102030Difference (linear scale) |
| Outcome | HR (95% CI) | |
|---|---|---|
| Major hemorrhagic events | 1.26 (1.16–1.36) | |
| Fatal extracranial bleeding | 1.41 (1.18–1.70) | |
| Nonfatal extracranial bleeding | 2.07 (1.99–2.15) | |
| 0.512Hazard ratio (log scale) |
Original publication
Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation. JAMA. Published 21 December 2021. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →