Arrhythmias & electrophysiology
Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation : A Nationwide Cohort Study
Authors' conclusion
Among patients with cirrhosis and nonvalvular AF, initiators of rivaroxaban versus apixaban had significantly higher rates of major hemorrhage and similar rates of ischemic events and death. Initiation of warfarin versus apixaban also contributed to significantly higher rates of major hemorrhagic events, including hemorrhagic stroke.
Study context
- Population
- Patients with cirrhosis and nonvalvular atrial fibrillation (AF) initiating apixaban, rivaroxaban or warfarin; 2 US claims data sets (Medicare, Optum), 2013–20221:1 propensity score (PS)-matched
- Exposure
- Apixaban vs rivaroxaban and vs warfarin
- Outcome
- Ischemic stroke or systemic embolism; major hemorrhage (intracranial hemorrhage or major gastrointestinal bleeding)
Methodological detailspropensity-score matched, 1:1 matching, Nonrandomized treatment selection (limitation)
- Propensity-score matched
- 1:1 matching
- Nonrandomized treatment selection (limitation)
Main finding
As reported in the abstract
Major hemorrhage
Each group vs apixabanRD, per 1000 PY
Rivaroxaban
33.1(95% CI 12.9–53.2)
Warfarin
26.1(CI 6.8–45.3)
Each group vs apixabanHazard ratio (CI)
Rivaroxaban
1.47(1.11–1.94)
Warfarin
1.38(1.03–1.84)
Observational data: associations, not effects.
Further findings
| Outcome | RD (per 1000 PY) (CI) | |
|---|---|---|
| Hemorrhagic stroke — Warfarin vs Apixaban | 9.7 (2.2–17.2) | |
| −1001020Difference, per 1000 PY (linear scale) |
| Outcome | HR (CI) | |
|---|---|---|
| Hemorrhagic stroke — Warfarin vs Apixaban | 2.85 (1.24–6.59) | |
| 0.10.31310Hazard ratio (log scale) |
Major hemorrhage, subgroup and sensitivity analyses
- Consistently higher major hemorrhage with rivaroxaban across subgroup and sensitivity analyses
Original publication
Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation : A Nationwide Cohort Study. Ann Intern Med. Published 9 July 2024. doi:10.
Summarised from the published abstract; every number is checked against it