Arrhythmias & electrophysiology
Comparative effectiveness and safety of apixaban and rivaroxaban in older patients with atrial fibrillation: A population-based cohort study
Authors' conclusion
In patients with AF, 66 years or older, treatment with apixaban was associated with lower risk for major bleeding, with no difference in the 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
- Participants
- 42,617 vs 30,725
- Exposure
- Apixaban vs rivaroxaban
- Apixabann = 42,617
- Rivaroxabann = 30,725reference
- Outcome
- Major bleeding (primary safety outcome) and thromboembolic events (primary efficacy outcome)
- Follow-up
- 1 year
Methodological detailspopulation-based, inverse probability of treatment weighting
- Population-based
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Major bleeding; thromboembolic events
Apixaban
- Major bleeding
- 2.1%
- Thromboembolic events
- 2.2%
Rivaroxaban
- Major bleeding
- 3.2%
- Thromboembolic events
- 2.2%
Major bleeding
Apixaban2.1%
Rivaroxaban3.2%
Thromboembolic events
Apixaban2.2%
Rivaroxaban2.2%
Apixaban vs RivaroxabanHazard ratio (95% CI)
Major bleeding; absolute risk reduction 1.1%
0.65(0.59–0.71)
Thromboembolic events
1.02(0.92–1.13)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Apixaban | Rivaroxaban | HR (95% CI) | |
|---|---|---|---|---|
| Any bleeding · 1 year | 8.1% | 10.9% | 0.73 (0.69–0.77) | |
| 0.512Hazard ratio (log scale) |
Safety
| Outcome | Apixaban | Rivaroxaban | HR (95% CI) | |
|---|---|---|---|---|
| Major bleeding (primary safety outcome) · 1 year | 2.1% | 3.2% | 0.65 (0.59–0.71) | |
| 0.512Hazard ratio (log scale) |
Original publication
Comparative effectiveness and safety of apixaban and rivaroxaban in older patients with atrial fibrillation: A population-based cohort study. Heart Rhythm. Published 13 June 2024. doi:10.
Summarised from the published abstract; every number is checked against it