Apixaban ‘might be preferable’ to other DOACs due to lower GI bleeding risk
Click Here to Manage Email Alerts
Compared with other direct oral anticoagulants, apixaban was associated with lower rates of gastrointestinal bleeding but similar rates of ischemic stroke and all-cause mortality among adults with atrial fibrillation, data show.
Direct oral anticoagulants (DOACs) are commonly used to prevent strokes in persons with AF. However, there is not clear guidance for choosing among the four available DOACs because head-to head clinical trial data are not available, Wallis Lau, PhD, a lecturer in pharmacoepidemiology and drug safety at the University College London School of Pharmacy, and colleagues wrote in Annals of Internal Medicine.
“In this study of more than half a million patients across four countries, apixaban use was associated with lower risk for gastrointestinal (GI) bleeding and similar rates of stroke and all-cause mortality compared with dabigatran, edoxaban and rivaroxaban,” Lau told Healio. “This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials.”
Lau and colleagues analyzed data from 527,226 adults newly diagnosed with AF from 2010 to 2019 who received a new DOAC prescription in France, Germany, the U.K. and the U.S., including 281,320 apixaban (Eliquis, Bristol Myers Squibb/Pfizer) users, 61,008 dabigatran (Pradaxa, Boehringer Ingelheim) users, 12,722 edoxaban (Savaysa, Daiichi Sankyo) users and 172,176 rivaroxaban (Xarelto, Janssen/Bayer) users. Researchers estimated database-specific HRs for ischemic stroke or systemic embolism, intracranial hemorrhage, GI bleeding and all-cause mortality across DOACs, stratified by propensity score and pooled using a random-effects model.
Researchers found that use of apixaban was associated with lower rates of GI bleeding compared with other DOACs; however, users of apixaban experienced similar rates of ischemic stroke or systemic embolism, intercranial hemorrhage and all-cause mortality compared with other DOACs.
Apixaban was associated with lower risk for GI bleeding compared with dabigatran (HR = 0.81; 95% CI, 0.7-0.94), edoxaban (HR = 0.77; 95% CI, 0.66-0.91) or rivaroxaban (HR = 0.72; 95% CI, 0.66-0.79), Lau and colleagues found.
Results persisted in analyses restricted to adults aged 80 years or older. Researchers also noted consistent associations between lower GI bleeding risk and apixaban vs. rivaroxaban among patients receiving the standard dose (HR = 0.72; 95% CI, 0.64-0.82), those receiving a reduced dose (HR = 0.68; 95% CI 0.61-0.77) and those with chronic kidney disease (HR = 0.68; 95% CI, 0.59-0.77)
“Our results indicated that apixaban might be preferable to other DOACs because of the lower rate of GI bleeding and similar rates of stroke, which warrant confirmation by head-to-head randomized controlled trials,” Lau told Healio. “As with all treatment choices, a wide consideration of all potential risks and benefits with respect to the patient’s profile would be needed when choosing an oral anticoagulant.”
For more information:
Wallis Lau, PhD, can be reached at wallis.lau@ucl.ac.uk; Twitter: @wallis_lau.
Collapse
Click Here to Manage Email Alerts