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Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world. | LitMetric

AI Article Synopsis

  • Apixaban and rivaroxaban are both approved for treating acute venous thromboembolism (VTE), but recent studies aimed to compare their effectiveness and safety directly in real-world settings.
  • A meta-analysis involving over 24,000 patients found that while apixaban and rivaroxaban had similar rates of recurrent VTE, apixaban was associated with a lower risk of both major and minor bleeding events.
  • Specifically, apixaban showed a significantly reduced incidence of clinically relevant major bleeding (0.74% vs. 1.03%) and nonmajor bleeding (4.95% vs. 8.77%) compared to rivaroxaban.

Article 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; = .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; = .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; < .01). Apixaban shows equivalent efficacy in prevention of recurrent VTE but decreased risk of major and minor bleeding events compared with rivaroxaban.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693001PMC
http://dx.doi.org/10.1182/bloodadvances.2019000572DOI Listing

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