Key result
Low-dose apixaban was associated with a significantly greater risk of ischemic stroke or systemic embolism (HR 1.95) compared to standard-dose apixaban, whereas no significant difference was observed between low- and standard-dose rivaroxaban.
Why the study?
Low-dose direct oral anticoagulant use is prevalent in clinical practice, but evidence on its effectiveness and safety compared with standard doses in AF remains limited.
Does low-dose rivaroxaban or apixaban improve safety or compromise effectiveness compared to standard-dose in patients with atrial fibrillation?
Population
Older adults with AF discharged from hospital newly prescribed rivaroxaban or apixaban
Comparison
Low-dose vs standard-dose rivaroxaban (15 mg vs 20 mg) and apixaban (2.5 mg vs 5 mg)
Design
Retrospective inverse probability treatment weighting cohort study
Authors
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Low-dose apixaban was associated with higher stroke/SE and mortality risks in AF without bleeding reduction; leaves open optimal dosing pending randomized confirmation.
Cohort (n=16,967)
Does low-dose rivaroxaban or apixaban improve safety or compromise effectiveness compared to standard-dose in patients with atrial fibrillation?
Hazard Ratio: 1.95 (95% CI 1.38–2.76)
Absolute Event Rate: 2.4% vs 1.2%
p-value: p=0.0002
Perreault et al. (2022) conducted a cohort in Atrial fibrillation (n=16,967). Low-dose apixaban vs. Standard-dose apixaban (5 mg twice daily) was evaluated on Ischemic stroke or systemic embolism (HR 1.95, 95% CI 1.38-2.76, p=0.0002). Low-dose apixaban was associated with a significantly greater risk of ischemic stroke or systemic embolism (HR 1.95) compared to standard-dose apixaban, whereas no significant difference was observed between low- and standard-dose rivaroxaban.
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