What is the clinical evidence from this study?

Study design: Cohort. Population: venous thromboembolism (n=8187). Intervention: Apixaban vs. Rivaroxaban. Primary outcome: all-cause mortality (absolute risk difference -0.48%, 95% CI -1.49 to 0.72).

What question did this study set out to answer?

To compare the risks of all-cause mortality, recurrent venous thromboembolism (VTE), and hospitalized bleeding between patients with VTE treated with rivaroxaban versus apixaban.

June 22, 2018European Heart Journal - Cardiovascular PharmacotherapyOpen Access

Safety and effectiveness of rivaroxaban and apixaban in patients with venous thromboembolism: a nationwide study

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Key result

Apixaban and rivaroxaban showed no significant differences in 180-day risks of all-cause mortality (5.08% vs 4.60%; ARD -0.48%), recurrent VTE, or hospitalized bleeding in patients with VTE.

Why the study?

Does apixaban compared to rivaroxaban reduce mortality, recurrent VTE, or bleeding in patients with venous thromboembolism?

Population

8,187 patients with venous thromboembolism in Denmark. Apixaban group: median age 70, 50% male. Rivaroxaban…

Comparison

Apixaban vs Rivaroxaban

Design

Cohort

Follow-up

180 days

Authors

CSCaroline Sindet‐PedersenHerlev Hospital LSLaila StærkAmager Hospital JPJannik Langtved PallisgaardElectrophysiology

Discussion

Member takes

Implication

Comparable VTE outcomes observed with apixaban and rivaroxaban; leaves open confirmation by randomized trials.

Key Points

To compare the risks of all-cause mortality, recurrent venous thromboembolism (VTE), and hospitalized bleeding between patients with VTE treated with rivaroxaban versus apixaban.
Conducted a nationwide registry-based study in Denmark including 8,187 patients with VTE treated with apixaban (N=1,504) or rivaroxaban (N=6,683) between 1 January 2015 and 30 June 2017.
Estimated 180-day standardized absolute risks using outcome-specific Cox proportional hazards regression models adjusted for potential confounding variables.
The 180-day risk of all-cause mortality was 5.08% (95% CI 4.08%–6.08%) with apixaban versus 4.60% (95% CI 4.13%–5.18%) with rivaroxaban (absolute risk difference: -0.48%, 95% CI -1.49% to 0.72%).
The 180-day risk of recurrent VTE was 2.16% (95% CI 1.49%–2.88%) with apixaban versus 2.22% (95% CI 1.89%–2.52%) with rivaroxaban (absolute risk difference: 0.06%, 95% CI -0.72% to 0.79%).
The 180-day risk of hospitalized bleeding was 1.73% (95% CI 1.22%–2.35%) with apixaban versus 1.89% (95% CI 1.56%–2.20%) with rivaroxaban (absolute risk difference: 0.16%, 95% CI -0.59% to 0.81%).

Study Design

Type

Cohort (n=8,187)

Multicenter

Yes

Structured PICO

Does apixaban compared to rivaroxaban reduce mortality, recurrent VTE, or bleeding in patients with venous thromboembolism?

Population

8,187 patients with venous thromboembolism treated with either rivaroxaban or apixaban in Denmark, evaluated for 180-day clinical outcomes.

Exposure

Apixaban

Comparator

Rivaroxaban

Outcome

All-cause mortality, recurrent VTE, and hospitalized bleeding at 180 dayshard clinical

Main Result

Absolute Risk Reduction: -0.48 (95% CI -1.49–0.72)

Absolute Event Rate: 5.08% vs 4.6%

Absolute Risk Reduction: -0.48%

In a nationwide cohort of VTE patients, apixaban and rivaroxaban showed similar safety and effectiveness profiles at 180 days.

Cite This Study

Sindet‐Pedersen et al. (2018) conducted a cohort in venous thromboembolism (n=8,187). Apixaban vs. Rivaroxaban was evaluated on all-cause mortality (absolute risk difference -0.48%, 95% CI -1.49 to 0.72). Apixaban and rivaroxaban showed no significant differences in 180-day risks of all-cause mortality (5.08% vs 4.60%; ARD -0.48%), recurrent VTE, or hospitalized bleeding in patients with VTE.

synapsesocial.com/papers/6a858128b451cea71dae6521 https://doi.org/10.1093/ehjcvp/pvy021

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Safety and effectiveness of rivaroxaban and apixaban in patients with venous thromboembolism: a nationwide study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Safety and effectiveness of rivaroxaban and apixaban in patients with venous thromboembolism: a nationwide study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider