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Apixaban is safer and more effective than rivaroxaban for non-valvular atrial fibrillation Therapeutics Initiative (University of British Columbia)

Description

Background: Non-valvular atrial fibrillation (NVAF) poses risks of mortality and thromboembolic events, necessitating anticoagulant therapy. Direct oral anticoagulants (DOACs) such as apixaban and dabigatran have emerged as alternatives to warfarin due to their convenience. Choosing the appropriate DOAC involves weighing benefits against risks, considering patient factors and preferences. Methods: A systematic review of observational studies directly comparing the effectiveness and safety of apixaban with other DOACs for NVAF was conducted. Cohort studies totaling 2,936,126 participants were analyzed, with meta-analysis conducted on 27 studies (N=2,135,415) reporting total event numbers. Primary outcomes including total mortality, major bleeding and thromboembolic events, were analyzed and compared across DOACs. Results: Apixaban had lower risks of major bleeding compared to dabigatran and rivaroxaban, while demonstrating similar efficacy in preventing stroke and systemic embolism. Apixaban was associated with a reduced risk of total mortality, ischemic stroke, and intracranial hemorrhage compared to rivaroxaban. Apixaban and dabigatran exhibited similar risks of death and intracranial hemorrhage, but apixaban showed superiority in preventing systemic embolism or stroke when compared to dabigatran. Conclusions: Observational evidence consistently favours apixaban over rivaroxaban, dabigatran, and edoxaban as the preferred first choice DOAC for NVAF patients accepting twice-daily dosing. Given its efficacy and safety profile, particularly in reducing major bleeding, apixaban is a suitable option for long-term anticoagulation in NVAF patients, supported by the recent availability of cost saving generic formulations.

Item Metadata

Title
Apixaban is safer and more effective than rivaroxaban for non-valvular atrial fibrillation
Alternate Title
Therapeutics Letter 146
Creator
Therapeutics Initiative (University of British Columbia)
Date Issued
2023-12
Description
Background: Non-valvular atrial fibrillation (NVAF) poses risks of mortality and thromboembolic events, necessitating anticoagulant therapy. Direct oral anticoagulants (DOACs) such as apixaban and dabigatran have emerged as alternatives to warfarin due to their convenience. Choosing the appropriate DOAC involves weighing benefits against risks, considering patient factors and preferences. Methods: A systematic review of observational studies directly comparing the effectiveness and safety of apixaban with other DOACs for NVAF was conducted. Cohort studies totaling 2,936,126 participants were analyzed, with meta-analysis conducted on 27 studies (N=2,135,415) reporting total event numbers. Primary outcomes including total mortality, major bleeding and thromboembolic events, were analyzed and compared across DOACs. Results: Apixaban had lower risks of major bleeding compared to dabigatran and rivaroxaban, while demonstrating similar efficacy in preventing stroke and systemic embolism. Apixaban was associated with a reduced risk of total mortality, ischemic stroke, and intracranial hemorrhage compared to rivaroxaban. Apixaban and dabigatran exhibited similar risks of death and intracranial hemorrhage, but apixaban showed superiority in preventing systemic embolism or stroke when compared to dabigatran. Conclusions: Observational evidence consistently favours apixaban over rivaroxaban, dabigatran, and edoxaban as the preferred first choice DOAC for NVAF patients accepting twice-daily dosing. Given its efficacy and safety profile, particularly in reducing major bleeding, apixaban is a suitable option for long-term anticoagulation in NVAF patients, supported by the recent availability of cost saving generic formulations.
Subject
Anticoagulants; Apixaban; Atrial Fibrillation; Drug Costs; Rivaroxaban; Stroke; Systematic Review; Thromboembolism
Genre
Other
Type
Text
Language
eng
Notes
The UBC TI is funded by the BC Ministry of Health to provide evidence-based information about drug therapy. We neither formulate nor adjudicate provincial drug policies.
Date Available
2024-09-25
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0445447
URI
http://hdl.handle.net/2429/89288
Affiliation
Medicine, Faculty of; Anesthesiology, Pharmacology and Therapeutics, Department of
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
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Attribution-NonCommercial-NoDerivatives 4.0 International