Apixaban may be a more effective treatment option than rivaroxaban for patients presenting with atrial fibrillation (AFib) and valvular heart disease (VHD), according to a new analysis published in Annals of Internal Medicine.[1]
The study’s authors noted that apixaban and rivaroxaban are the two direct oral anticoagulants (DOACs) most commonly prescribed to patients presenting with both AFib and VHD. The patient’s diet does not impact their effectiveness, which makes them favorites of both prescribing physicians and patients alike.
The group examined data from nearly 20,000 patients who treated with one of the two popular DOACs. All patients presented with AFib and VHD. While 50% of patients were treated with apixaban, the other 50% were treated with rivaroxaban. This was not a randomized controlled trial (RCT), however; instead, the patients were matched based on age and other characteristics.
“The lack of clinical trial evidence and wide use of both drugs in patients with AFib and VHD calls for real-world evidence that can guide treatment selection in clinical practice,” wrote first author Ghadeer Dawwas, PhD, MSc, a post-doctoral fellow with the Perelman School of Medicine at the University of Pennsylvania, said in a prepared statement.
Overall, apixaban was linked to a 43% lower risk of the patient experiencing a clotting event and a 49% lower risk of experiencing a gastrointestinal or intracranial bleeding event. Dawwas et al. found that 0.52% of patients experienced a stroke or systemic embolism when given apixaban. With rivaroxaban, that number was 0.91%. The same 2:1 ratio in apixaban’s favor was also seen when evaluating the risk of a bleeding event.
“Until evidence from RCTs becomes available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AFib and VHD,” senior author Sean Hennessy, PharmD, PhD, a professor of epidemiology and director of the Perelman School of Medicine’s Center for Real-world Effectiveness and Safety of Therapeutics, said in the same statement.
The team’s analysis was funded by the National Institutes of Health.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.