Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data
US retrospective study of adults with VTE found new users of apixaban had lower rates of recurrent VTE (HR 0.77; 95% CI 0.69 to 0.87]) and gastrointestinal and intracranial bleeding (0.60; 0.53 to 0.69) than new users of rivaroxaban.
Source:
Annals of Internal Medicine
SPS commentary:
The authors comment that it is not known why apixaban may be more effective than rivaroxaban, but suggest one possibility is pharmacokinetics – one study found apixaban to have less fluctuation in plasma concentrations, a lower peak-to-trough ratio, and less variability in pharmacokinetic variables compared with rivaroxaban. They go on to highlight a number of limitations to their study, including the possibility of unmeasured confounding and outcome misclassification, lack of information on adherence, and the fact that only severe outcomes resulting in hospitalization were included.