Apixaban showed equivalent efficacy to rivaroxaban for preventing recurrent VTE (RR 0.89; 95% CI 0.67-1.19) but decreased the risk of major bleeding (RR 0.73; 95% CI 0.58-0.93).
Meta-Analysis (n=24,041)
Does apixaban reduce recurrent VTE and bleeding compared to rivaroxaban in patients with acute VTE in real-world settings?
In real-world settings, apixaban demonstrates similar efficacy to rivaroxaban for preventing recurrent VTE but is associated with a significantly lower risk of major and clinically relevant nonmajor bleeding.
Relative Risk: 0.89 (95% CI 0.67–1.19)
Absolute Event Rate: 1.14% vs 1.35%
p-value: p=.45
Abstract Both apixaban and rivaroxaban have been approved for use in acute venous thromboembolism (VTE). Although indirect comparison through network meta-analyses of randomized trials have been performed to compare the efficacy and safety of these agents, further comparison between these agents was lacking until recently. We sought to systematically review and carry out a meta-analysis of studies to further compare apixaban with rivaroxaban from multiple studies done in the real-world settings. Studies comparing rivaroxaban with apixaban in patients with acute VTE were identified through electronic literature searches of MEDLINE, EMBASE, Scopus, and the Cochrane library up to May 2019. Study-specific risk ratios (RRs) were calculated and combined using a random-effects model meta-analysis. In an analysis involving 24 041 patients, recurrent VTE within 6 months occurred in 56 of 4897 patients (1.14%) in the apixaban group and 258 of 19 144 patients (1.35%) in the rivaroxaban group (RR, 0.89; 95% confidence interval CI, 0.67-1.19; P = .45). Clinically relevant major bleeding occurred in 85 of 11 559 patients (0.74%) in the apixaban group and 350 of 33 909 patients (1.03%) in the rivaroxaban group (RR, 0.73; 95% CI, 0.58-0.93; P = .01). Clinically relevant nonmajor bleeding occurred in 169 of 3417 patients (4.95%) in the apixaban group and 1094 of 12 475 patients (8.77%) in the rivaroxaban group (RR, 0.59; 95% CI, 0.50-0.70; P .01). Apixaban shows equivalent efficacy in prevention of recurrent VTE but decreased risk of major and minor bleeding events compared with rivaroxaban.
Aryal et al. (2019) conducted a meta-analysis in acute venous thromboembolism (VTE) (n=24,041). Apixaban vs. Rivaroxaban was evaluated on recurrent VTE within 6 months (RR 0.89, 95% CI 0.67-1.19, p=.45). Apixaban showed equivalent efficacy to rivaroxaban for preventing recurrent VTE (RR 0.89; 95% CI 0.67-1.19) but decreased the risk of major bleeding (RR 0.73; 95% CI 0.58-0.93).