Daily Dose: Apixaban Safest in Afib

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On November 4, 2022, we reviewed a large-scale multinational cohort study published in Annals of Internal Medicine that compared all direct oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban, and rivaroxaban) in routine clinical practice.

The study

Researchers tapped 5 standardized electronic health care databases covering 221 million individuals in France, Germany, the United Kingdom, and the US for adults diagnosed with atrial fibrillation (AF) who were given a new prescription for a DOAC. The team identified 4 outcomes of interest: gastrointestinal (GI) bleeding, a composite of ischemic stroke and systemic embolism, intracranial hemorrhage (ICH), and all-cause mortality. Investigators used Cox regression models stratified by propensity score and pooled using a random-effects model to assess risk of each outcome.

In patients with AF, use of apixaban was associated with up to a 28% lower risk of GI bleeding when compared with dabigatran, edoxaban, and rivaroxaban.

Clinical implications

Investigators concluded that while their current results suggest that apixaban might be preferable to other DOACs based on the reduced risk for GI bleeding and similar rates of stroke and ICH, “…as with all treatment choices, a wider consideration of all potential risks and benefits” will still be necessary for individual patients.”

Click here for the full study review.