Study of claims data compares apixaban vs rivaroxaban for patients with atrial fibrillation and valvular heart disease (Eliquis better than Xarelto on listed concerns)

Medical Xpress / American College of Physicians / Annals of Internal Medicine ^ | Oct. 18, 2022 | Ghadeer K. Dawwas et al

[ConservativeMind]

A large, population-based study of patients with atrial fibrillation (AF) and valvular heart disease (VHD) found that use of apixaban was associated with a lower rate of ischemic stroke or systemic embolism and a lower rate of intracranial or gastrointestinal (GI) bleeding compared with rivaroxaban. The authors say clinicians should consider these findings when selecting anticoagulants in this patient population. The study is published in Annals of Internal Medicine.

VHD is common among patients with AF. The presence of VHD increases the risk for death, major adverse cardiovascular events, and major bleeding. Despite the common use of apixaban and rivaroxaban in this population, direct comparisons are lacking.

Researchers from the Perelman School of Medicine, University of Pennsylvania studied data from a large commercial health insurance database from January 2013 to December 2020 to emulate a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD.

Of the 33,907 patients included in the study, 23,712 took apixaban for the first time and 10,195 were treated with rivaroxaban. In the propensity score–matched sample of patients with AF and VHD, the incidence rate of ischemic stroke or systemic embolism per 1,000 person-years of follow-up was 5.2 among apixaban users and 9.1 among rivaroxaban users.

The incidence rate of GI or intracranial bleeding per 1,000 person-years of follow-up was 14.3 among apixaban users and 28.1 among rivaroxaban users. There was no statistically significant difference in all-cause mortality between the two groups.

Since there are no direct, randomized comparisons of apixaban and rivaroxaban in patients with both AF and VHD, these findings have important clinical implications for patients.

[ConservativeMind]

To translate, Eliquis is better on these concerns than Xarelto, but bith seem to cost about the same.

It may be worth choosing Eliquis, if you have a choice, but it didn’t appear to affect all cause mortality.

[ConservativeMind]

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[jacknhoo]

Eliquis nearly killed my sister. While in the hospital, they told her the receive on average about three patients like her, nearly dead from slow internal bleeding, every week.

Watch your symptoms if you’re taking it.

[MayflowerMadam]

I’m on it forevermore. I guess it’s hard to know what to watch out for as far as internal bleeding goes.

I just wish they release the generic. It’s SO expensive.

[cuban leaf]

I have AF and take no drugs. The Lord will take me at a time of his choosing. Life is a mist.

[Not_Who_U_Think]

I was placed on Enestro by my heart doc, about two years ago. Right before COVID. I was in Europe that Christmas, and after coming home I developed a nasty cough. I would wake up at night filled with phlegm. My GP gave a Spiriva inhaler that helped some, but still an aggravation that wouldn’t go away.

I complained to the heart doc who did nothing. I pointed out this was a contraindication but the PA just nodded. Finally, I became disgusted with playing the mask game and stopped going in, and they refused to renew my script unless I came in... so, I stopped it.

And low and behold, the phlegm and cough went away. I have normal BP - 120/80 and no problems — I suspect I was helping sponsor a nice trip to the conference in Cabo.