A study has shown that the use of apixaban for nonvalvular atrial fibrillation or NVAF seems better than rivaroxaban in reducing the risks of stroke and bleeding but is correlated with similar risks relative to dabigatran.
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Researchers conducted multicenter matched cohort
studies with secondary meta-analyses to evaluate the safety and effectiveness
of dabigatran, rivaroxaban, and apixaban across nine administrative healthcare
databases. Also, they included adults with NVAF initiating direct oral
anticoagulants or DOACs and divided them into three groups to compare DOACs
pairwise.
Primary endpoint was the pooled hazard ratio or pHR of
ischemic stroke or systemic thromboembolism; secondary ones were pHRs of major
bleeding and a composite of stroke, major bleeding, or all-cause mortality. Proportional
hazard Cox regression models were used, and pooled estimates were obtained through
random effect meta-analyses.
In total, there were 73,414 new users of dabigatran, 92,881
of rivaroxaban, and 61,284 of apixaban. For rivaroxaban vs dabigatran, the pHRs
were 1.11 for ischemic stroke or systemic embolism, 1.26 for major bleeding,
and 1.17 for the composite endpoint.
pHRs comparing apixaban to dabigatran were 0.91, and
1.17 for ischemic stroke or systemic embolism, major bleeding, and the composite
endpoint, correspondingly. For apixaban vs rivaroxaban, the corresponding pHRs
were as follows: 0.85, 0.61, and 0.83.
Source: Br J Clin Pharmacol 2021;87:2589-2601