Commonly prescribed direct oral anticoagulants for patients with non-valvular atrial fibrillation include apixaban and rivaroxaban, but there is a lack of compelling evidence to allow comparison of the two drugs. A recent retrospective cohort study has examined the safety of apixaban and rivaroxaban, by assessing the incidence of intracranial haemorrhage or gastrointestinal bleeding, and the effectiveness of the medications, by assessing the incidence of ischaemic stroke or systemic embolism. The study included 39,351 patients newly prescribed apixaban, propensity score matched to 39,351 patients newly prescribed rivaroxaban..

Patients prescribed apixaban had a lower incidence rate of intracranial haemorrhage or gastrointestinal bleeding (12.9 per 1,000 person-years)  compared to 21.9 per 1,000 person-years for patients prescribed rivaroxaban (hazard ratio [HR]: 0.58, 95% CI: 0.52-0.66), with a rate difference of 9.0 less events per 1,000 person-years (CI: 6.9-11.1). Lower rates of ischaemic stroke or systemic embolism were also seen among patients prescribed apixaban compared to those prescribed rivaroxaban, with the incidence rate being 6.6 per 1,000 person-years with apixaban and 8.0 per 1,000 person-years with rivaroxban (HR: 0.82, 95% CI: 0.68-0.98).

The lower incidence rates of major adverse events and better clinical outcomes associated with apixaban suggest that it may a safer and more effective medication in this setting, but the usual caveats regarding retrospective observational research apply. The study, published in the Annals of Internal Medicine, can be accessed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh