• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

Rivaroxaban associated with significantly increased risk of major ischemic or hemorrhagic events versus apixaban in patients with atrial fibrillation

byYuchen DaiandMichael Pratte
December 22, 2021
in Cardiology, Chronic Disease, Emergency, Neurology
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. In patients with atrial fibrillation over 65, treatment with rivaroxaban compared to apixaban was associated with a significantly increased risk of major ischemic or hemorrhagic events.

2. Patients receiving reduced doses of anticoagulants had increased relative and absolute risk of major ischemic or hemorrhagic events.

Evidence Rating Level: 2 (Good)

Study Rundown: Direct oral anticoagulants such as rivaroxaban and apixaban are the preferred anticoagulants for ischemic stroke prevention in patients with atrial fibrillation However, their comparative efficacy is unknown. This cohort study compared major ischemic and hemorrhagic outcomes in patients with atrial fibrillation who initiated anticoagulation treatment with rivaroxaban or apixaban. The primary endpoint was a composite of major ischemic (stroke/systemic embolism) and hemorrhagic (intracerebral hemorrhage/other intracranial bleeding/fatal extracranial bleeding) events. Secondary endpoints were nonfatal extracranial bleeding and total mortality (fatal ischemic/hemorrhagic event or other death during follow-up). Among 581,451 Medicare beneficiaries aged 65 or older with atrial fibrillation, the adjusted incidence of major ischemic or hemorrhagic events for rivaroxaban and apixaban was 16.1 vs 13.4 per 1,000 person-years respectively, a statistically significant difference. These results suggested that treatment with rivaroxaban compared to apixaban was associated with a significantly increased risk of major ischemic or hemorrhagic events in patients with atrial fibrillation. A limitation of this study was that a substantial proportion of patients discontinued treatment for reasons unrelated to the safety profile of anticoagulants, resulting in potential confounding of the results.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Trends and variation in oral anticoagulant choice in patients with atrial fibrillation

RELATED REPORTS

TRAPS: Rivaroxaban vs. Warfarin for Secondary Prevention in Antiphospholipid Syndrome [Classics Series]

Magnetic resonance imaging-guided fibrosis ablation plus pulmonary vein isolation non-superior to pulmonary vein isolation alone in preventing atrial arrhythmia recurrence: The DECAAF II trial

ANNEXA-A and ANNEXA-R trials: Andaxanet Alfa for Reversal of Apixaban and Rivaroxaban [Classics Series]

In-Depth [retrospective cohort]: This cohort study included 581,451 patients (mean age, 77.0 years; 291,966 [50.2%] women) with atrial fibrillation on rivaroxaban (n = 227,572) or apixaban (n = 353,879) treatment, where 134,393 (23.1%) patients received reduced doses. Patients were followed for up to 4 years between January 2013 to November 2018, for a total of 474,605 person-years of follow-up (median [IQR], 174 [62-397] days). Overall, the adjusted primary outcome rate for rivaroxaban vs apixaban was 16.1 vs 13,4 per 1,000 person-years respectively (RD, 2.7 [95%CI, 1.9-3.5]; HR, 1.18 [95%CI, 1.12-1.24]). Patients on rivaroxaban had increased risk for both major ischemic events (8.6 vs 7.6 per 1,000 person-years; RD, 1.1 [95%CI, 0.5-1.7]; HR, 1.12 [95%CI, 1.04-1.20]) and hemorrhagic events (7.5 vs 5.9 per 1,000 person-years; RD, 1.6 [95%CI, 1.1-2.1]; HR, 1.26 [95% CI, 1.16-1.36]), including fatal extracranial bleeding (1.4 vs 1.0 per 1,000 person-years; RD, 0.4 [95%CI, 0.2-0.7]; HR, 1.41 [95%CI, 1.18-1.70]). The rivaroxaban group had increased risk of nonfatal extracranial bleeding (39.7 vs 18.5 per 1,000 person-years; RD, 21.1 [95%CI, 20.0-22.3]; HR, 2.07 [95%CI, 1.99-2.15]), fatal ischemic/hemorrhagic events (4.5 vs 3.3 per 1000 person-years; RD, 1.2 [95%CI, 0.8-1.6]; HR, 1.34 [95%CI, 1.21-1.48]), and total mortality (44.2 vs 41.0 per 1,000 person-years; RD, 3.1 [95%CI, 1.8-4.5]; HR, 1.06 [95%CI, 1.02-1.09]). Lastly, patients receiving both the reduced dose (27.4 vs 21.0 per 1,000 person-years; RD, 6.4 [95%CI, 4.1-8.7]; HR, 1.28 [95%CI, 1.16-1.40]) and the standard dose (13.2 vs 11.4 per 1,000 person-years; RD, 1.8 [95%CI, 1.0-2.6]; HR, 1.13 [95%CI, 1.06-1.21]) of rivaroxaban had increased risk of the primary outcome.

Image: PD

©2021 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: anticoagulantanticoagulationapixabanatrial fibrillationrivaroxaban
Previous Post

#VisualAbstract: Neoadjuvant chemotherapy plus surgery improves overall survival compared to surgery alone in locally advanced esophageal cancer

Next Post

Omega-3 fatty acid supplements did not reduce depression risk in adults compared to placebo

RelatedReports

The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Critical, Emergent and Pulmonary Care Classics

TRAPS: Rivaroxaban vs. Warfarin for Secondary Prevention in Antiphospholipid Syndrome [Classics Series]

June 23, 2022
Rivaroxaban likely reduces risk of recurrent stroke in specific subgroup of patients with embolic stroke of undetermined source
Cardiology

Magnetic resonance imaging-guided fibrosis ablation plus pulmonary vein isolation non-superior to pulmonary vein isolation alone in preventing atrial arrhythmia recurrence: The DECAAF II trial

June 22, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Critical, Emergent and Pulmonary Care Classics

ANNEXA-A and ANNEXA-R trials: Andaxanet Alfa for Reversal of Apixaban and Rivaroxaban [Classics Series]

June 21, 2022
The ABCD2 score: Risk of stroke after Transient Ischemic Attack (TIA) [Classics Series]
Critical, Emergent and Pulmonary Care Classics

RE-VERSE AD Trial: Idarucizumab for the Reversal of Anticoagulation by Dabigatran [Classics Series]

June 20, 2022
Next Post
Higher omega-3 blood levels associated with larger brain volumes

Omega-3 fatty acid supplements did not reduce depression risk in adults compared to placebo

#VisualAbstract: Pericardiotomy after cardiac surgery may reduce the incidence of postoperative atrial fibrillation

#VisualAbstract: The use of COVID-19 convalescent plasma not beneficial to patients hospitalized with COVID-19

Ultrasound enhances gastrointestinal absorption of drugs at low frequencies

Wellness Check: Addictions

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Vitamin and mineral supplementation associated with minimal to no benefit in the primary preventing of cardiovascular disease and cancer – US Preventative Services Task Force
  • RSVpreF vaccine prevents symptomatic respiratory syncytial virus infection
  • Incidence of Kawasaki disease found to be lower during the COVID-19 pandemic in the United States
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.