For patients with venous thromboembolism (VTE), new users of apixaban have lower rates of recurrent VTE and bleeding compared with new users of rivaroxaban, according to a study published online Dec. 7 in the Annals of Internal Medicine.

Ghadeer K. Dawwas, Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues examined the effectiveness and safety of apixaban compared with rivaroxaban in patients with VTE in a retrospective cohort study conducted from Jan. 1, 2015, to June 30, 2020. A total of 18,618 new users of apixaban and 18,618 new users of rivaroxaban were included from 49,900 eligible patients with VTE.

The researchers found that after propensity score matching, the rates of recurrent VTE and bleeding were lower in association with apixaban versus rivaroxaban (hazard ratios, 0.77 and 0.60, respectively). The absolute reduction in the probability of recurrent VTE with apixaban versus rivaroxaban was 0.006 and 0.011 within two and six months of initiation, respectively. With apixaban versus rivaroxaban, the absolute reduction in the probability of gastrointestinal and intracranial bleeding was 0.011 and 0.015 within two and six months of initiation, respectively.

"These findings suggest that apixaban has superior effectiveness and safety compared with rivaroxaban and may provide guidance to clinicians and patients regarding selection of an anticoagulant for treatment of VTE," the authors write.