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In an observational study of patients with venous thromboembolism, short-term rates of recurrence and major bleeding were similar with the two drugs. The most widely prescribed direct-acting oral anticoagulants in the U.S., apixaban and rivaroxaban, have not been compared head-to-head in randomized trials. In this observational study of consecutive patients from a Mayo Clinic thrombophilia clinic, researchers compared outcomes in 302 patients who received apixaban and 298 who received rivaroxaban to treat acute venous thromboembolism (VTE) for a minimum of 3 months (median, ≈4 months). About 20% of patients had unprovoked VTE, about 40% had active cancer, and nearly all had creatinine clearance >50 mL/minute. Analyses were adjusted for modest baseline differences between the two groups. Rates of both recurrent VTE and major bleeding were slightly (but not statistically significantly) higher with apixaban than with rivaroxaban (recurrent VTE, 4 vs. 2 events per 100 person-years; major bleeding, 6 vs. 3 events per 100 person-years). Rates of clinically relevant nonmajor bleeding were slightly higher with rivaroxaban than with apixaban (7 vs. 4 events per 100 person-years; P=0.03). |
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In this study, efficacy and safety outcomes were comparable for apixaban and rivaroxaban during relatively short-duration treatment. A recent larger observational study suggested a slight advantage for apixaban, but that study involved insurance claim data, which might be less reliable than the data analyzed in the current study (NEJM JW Gen Med Feb 15 2019 and Lancet Haematol 2019; 6:20). Patients in Mayo Clinic’s thrombophilia clinic might not be representative of VTE patients in general practice; however, the authors imply that most VTE patients in their system — which provides both primary care and highly specialized tertiary care — are managed in this clinic.