Apixaban is associated with lower rates of major and gastrointestinal bleeding than rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF), according to a new meta-analysis published in the American Journal of Cardiology.
"In the absence of direct head-to-head randomized controlled trials between these two direct oral anticoagulants, comparison by way of a meta-analysis informed by real-world evidence may offer the best insights for treatment selection when deciding which treatment option to pursue," wrote lead author Mamas A. Mamas, MBChB, with the Center for Prognosis Research at Keele University in the United Kingdom, and colleagues.
The authors ultimately selected 13 publications reporting on 10 different studies. This covered a total of 592,772 participants. While 281,013 patients were given apixaban for NVAF, the remaining 311,759 patients were given rivaroxaban.
The original studies were performed from January 2012 to February 2018. Also, the mean patient age ranged from 68 years old to 78.3 years old; the percentage of male patients ranged from 47.2% to 63.2%.
Primary outcomes included all-cause hospitalization, stroke and major bleeding, stroke and systemic embolism.
Overall, the authors found that the adjusted hazard ratio from the meta-regression analyses was 0.88 to 0.95, indicating a significantly lower hazard of stroke/systemic embolism associated with apixaban compared with rivaroxaban.
The authors also found that pair-wise meta-analyses showed that the pooled hazards of a major bleeding episode were significantly lower with apixaban than rivaroxaban. However, apixaban was also associated with a lower risk of gastrointestinal bleeding than rivaroxaban.
There was no significant difference in ischemic stroke between the two DOACs.
However, apixaban was associated with a notably lower risk of hemorrhagic stroke than rivaroxaban.
"The findings from this summary of evidence demonstrate that apixaban is associated with lower rates of both major and gastrointestinal bleeding than rivaroxaban, with no loss of efficacy, which corroborates recent direct and indirect comparisons between the treatments," the authors wrote.
Read the full study here.