A Systematic Review of Network Meta-Analyses and Real-World Evidence Comparing Apixaban and Rivaroxaban in Nonvalvular Atrial Fibrillation. (3rd January 2020)

• Record Type: Journal Article
• Authors: Hill, Nathan R.; Sandler, Belinda; Bergrath, Evelien; Milenković, Dušan; Ashaye, Ajibade O.; Farooqui, Usman; Cohen, Alexander T.
• Is Part Of: Clinical and applied thrombosis/hemostasis. Volume 26(2020)
• Publication Date: 2020-01-03
• Subjects: nonvalvular atrial fibrillation -- direct oral anticoagulants -- apixaban -- rivaroxaban -- major bleeding -- stroke -- systematic review; Hemostasis -- Periodicals; Thrombosis -- Periodicals; 616.13
• DOI: 10.1177/1076029619898764
• Languages: English
• ISSNs: 1076-0296

Abstract

There is no direct evidence comparing the 2 most commonly prescribed direct oral anticoagulants, apixaban and rivaroxaban, used for stroke prevention in nonvalvular atrial fibrillation (NVAF). A number of network meta-analyses (NMAs) of randomized control trials and real-world evidence (RWE) studies comparing the efficacy, effectiveness, and safety of apixaban and rivaroxaban have been published; however, a comprehensive evidence review across the available body of evidence is lacking. In this study, we aimed to systematically review and evaluate the clinical outcomes of apixaban and rivaroxaban using a combination of data gleaned from both NMAs and RWE studies. The review identified 21 NMAs and 5 RWE studies. The data demonstrated that apixaban was associated with fewer major bleeding events compared to rivaroxaban. There was no difference in the efficacy/effectiveness profiles between these treatments. Bleeding is a serious complication of anticoagulation therapy for the management of NVAF, and is associated with increased rates of hospitalization, morbidity, mortality, and health-care expenditure. The majority of studies in this comprehensive evidence review suggests that apixaban has a lower risk of major bleeding events compared to rivaroxaban in patients with NVAF.