Key result
Rivaroxaban linked to ~141% higher GI bleeding hospitalization risk and increased intracranial bleeding vs apixaban.
Why the study?
Apixaban and rivaroxaban are the most prescribed direct oral anticoagulants, but the safety of different doses in patients at high risk for bleeding is not fully defined.
Do specific doses of rivaroxaban and apixaban affect the rate of hospitalizations due to bleeding and all-cause mortality compared to apixaban 5 mg in Medicare beneficiaries?
Population
More than 1.9 million Medicare beneficiaries who filled prescriptions for apixaban or rivaroxaban
Comparison
Apixaban vs rivaroxaban at specific doses
Design
Retrospective cohort study
Authors
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May increase bleeding hospitalizations with rivaroxaban versus apixaban 5 mg; leaves open confirmation by randomized trials.
Cohort (n=1,900,000)
Yes
Do specific doses of rivaroxaban and apixaban affect the rate of hospitalizations due to bleeding and all-cause mortality compared to apixaban 5 mg in Medicare beneficiaries?
Effect estimate: HR 2.41 (95% CI 2.15-2.70)
In Medicare beneficiaries, rivaroxaban doses of 15 mg or greater are associated with a significantly higher risk of hospitalization for bleeding compared to apixaban 5 mg.
Vest et al. (2025) conducted a cohort in Patients prescribed apixaban or rivaroxaban (n=1,900,000). Rivaroxaban vs. Apixaban 5 mg was evaluated on Hospitalization due to gastrointestinal bleeding (HR 2.41, 95% CI 2.15-2.70). Compared to apixaban 5 mg, rivaroxaban 15-20 mg was associated with a higher risk of hospitalization due to GI bleeding (HR 2.41; 95% CI 2.15-2.70) and intracranial bleeding (HR 1.51).
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