Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients

Abstract

In the real-world setting after controlling for differences in patient characteristics, apixaban is associated with significantly lower risk of S/SE and MB than rivaroxaban and warfarin, and a trend towards better outcomes vs. dabigatran among elderly NVAF patients in the US.

Comparative safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation in clinical practice in Scotland

“…However, other studies also reported bleeding risks to be higher among rivaroxaban patients than among patients using dabigatran [38][39][40][41], a finding that was observed for other bleeds but not gastrointestinal bleeding in our study; this could, however, be due to different definitions of bleeding being used. As in this study, several other studies reported no differences in bleeding events between apixaban and dabigatran [36,37,39]; most other studies also did not find any differences with regard to haemorrhagic stroke.…”

“…In this study, no significant differences between DOACs were found in the risks of strokes, systemic embolism, transient ischaemic attacks or combinations thereofin line with the majority of previously published research. Other observational studies also found no differences in the risk of stroke between dabigatran and rivaroxaban [38], the combination of stroke/systemic embolism between apixaban and dabigatran [37] or between any of the DOACs [41], or a composite outcome of stroke, systemic embolism and death across all DOACs [39], principally confirming conclusions made based on indirect comparisons between DOACs using clinical trial data [12][13][14]. Unlike the results with regard to these primary outcomes, which have shown high agreement across studies, findings relating to secondary outcomes were nevertheless varied.…”

“…Similar findings have been reported before, albeit with some variation in individual results. Several previous studies have highlighted differences in bleeding risks between rivaroxaban and apixaban, with risks for gastrointestinal bleeding , other major bleeding and overall bleeding risks all significantly higher among rivaroxaban patients. However, other studies also reported bleeding risks to be higher among rivaroxaban patients than among patients using dabigatran , a finding that was observed for other bleeds but not gastrointestinal bleeding in our study; this could, however, be due to different definitions of bleeding being used.…”

“…This was the first study in Scotland using linked data to analyse the clinical effectiveness and safety of DOAC treatment in patients with AF, and one of a growing number of Table 2 Crude incidence rates for all outcomes except composites, by drug prescribed international observational studies directly comparing the individual DOACseither focusing on safety [35,36], or analysing both safety and effectiveness [37][38][39][40][41]. As one of the few nationwide studies conducted outside the US thus far, it provides exceptional population coverage.…”

Safety and effectiveness of apixaban in Japanese patients with nonvalvular atrial fibrillation in clinical practice: A regulatory postmarketing surveillance, the STANDARD study

“…Apixaban received regulatory approval in Japan in 2012 for the prevention of ischemic stroke and SE in patients with NVAF. To date, the real‐world safety and effectiveness of apixaban in patients with NVAF have been assessed in retrospective claims database studies both outside of Japan and in Japan . However, data are still limited in Japanese NVAF patients.…”