The likelihood of gastrointestinal (GI) bleeding is approximately 20-28% lower in patients with atrial fibrillation (AF) Take Apixaban Observational studies comparing (Eliquis) with other direct oral anticoagulants (DOACs) suggest: There was no difference in risk between DOACs. ischemic stroke or systemic embolism, intracranial hemorrhage (ICH), or death.
Low-dose apixaban and low-dose apixaban reduced the risk of gastrointestinal bleeding Rivaroxaban (Xarelto) proposed an analysis of over 500,000 atrial fibrillation patients taking any of the four DOACs. stroke preventionIn this study, or something (Lixiana) and dabigatran (Pradaxa).
The results showed that patients aged 80 and over chronic kidney disease (CKD).
The findings “suggest that apixaban may be preferred over other DOACs due to lower rates of gastrointestinal bleeding and similar stroke rates,” said University College London Hospital, UK. Dr Wallis CY Lau of the NHS Foundation Trust said. theheart.org| Medscape Cardiology.
She added that “all potential risks and benefits should be broadly considered” as well as individual patient characteristics and preferences when choosing a DOAC.
Lau is the lead author of the study Published October 31 in the Annals of internal medicineThe findings are novel to include edoxaban in comparison to apixaban, the report states: solid in line Several other observational study.
However, confirmation from one-to-one trials and large-scale real-world studies is lacking, and “clinicians have no clear help in choosing DOACs,” said Lau. Current research brings “unprecedented precision and power” to the comparison of all four of his DOACs in a real-world setting.
Geoffrey D. Barnes, MD, MSc, University of Michigan, Ann Arbor, said: The story says, “Apixaban use is associated with less risk of gastrointestinal bleeding than other direct oral anticoagulants.”
That information, Barnes observed, is already put into practice in most cases. theheart.org| Medscape Cardiologyalong with apixaban, are “currently the most prescribed oral anticoagulants in the United States.”
Barnes, who was not part of the current study, cautioned that it lives up to all the limitations expected from observational, non-prospective data. I think I did,” he said. Their approach was “very thorough and robust.”
“What was very appealing about this particular analysis was that it wasn’t just about one dataset or just one country,” Barnes said. I did.” This helps to “minimize, but not eliminate, some of the country-specific nuances” that are potential confounding factors.
In fact, researchers tapped into five health registries containing approximately 221 million primary care and outpatient and inpatient patients in France, Germany, the United Kingdom, and the United States.
They focused on 527,226 adult patients who received their first DOAC prescription after newly diagnosed atrial fibrillation between 2010 and 2019. The prescriptions were 53.4% apixaban, 32.7% rivaroxaban, 11.6% dabigatran and 2.4% edoxaban. The median follow-up ranged from 534 days to 1612 days (1.4 to 4.4 years) for the DOAC group and individual datasets, the report noted.
In an analysis adjusted for propensity scoring to smooth patient differences across the five data sets, the risk of gastrointestinal bleeding in patients taking apixaban was compared with the risk of each of the other DOACs. The hazard ratio (HR) of apixaban was
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0.72 (95% CI, 0.66–0.79) vs rivaroxaban
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0.81 (95% CI, 0.70 – 0.94) vs dabigatran
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0.77 (95% CI, 0.66 to 0.91) vs edoxaban
None of the HRs in the corresponding analyzes of ischemic stroke or systemic embolism, ICH, or all-cause mortality were significant.
Gastrointestinal bleeding and clinical outcome findings were similar in patients aged 80 years and older compared with the overall population.
Apixaban was superior to rivaroxaban even when both drugs were administered at standard dose reductions of 2.5 mg twice daily and 15 mg once daily, respectively: HR 0.68 (CI, 0.61 – 0.77 ).
A similar superiority of apixaban and rivaroxaban for gastrointestinal bleeding was observed in an analysis that included only CKD patients: HR 0.68 (95% CI, 0.59 – 0.77). Apixaban outperformed dabigatran even in such cases: HR 0.71 (95% CI, 0.54 to 0.94).
Without data directly comparing the safety of DOACs, “I don’t think we’ll see guidelines for choosing one drug over the other based solely on bleeding risk,” Barnes said.
“But even in the opinion of individual clinicians and experts, rivaroxaban is still a very good choice, even though patients at high bleeding risk may start with apixaban as a first choice.”
Barnes pointed to an ongoing randomized trial investigating this very issue.of Cobra’s In a trial with an estimated enrollment of 3018, patients with newly diagnosed atrial fibrillation were randomized to receive either apixaban 5 mg twice daily or rivaroxaban 20 mg once daily. assigned to act. Patients will be evaluated after 12 months, primarily for adjudicated clinically relevant bleeding.
Lau reveals that he has received a grant for his institution from the Hong Kong Innovative Technology Council. Disclosures of other authors can be found at acponline.org.Burns reports both consulting Janssen and the Pfizer/Bristol-Myers Squibb Alliance have previously Acelis Connected Health, Abbott Vascular, Boston Scientific.
uninternedPublished online on October 21, 2022. Overview
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