One could easily become perplexed as to which direct-acting oral anticoagulant (DOAC) agent would be suitable for treating Venous thromboembolism (VTE).  Might it be rivaroxaban? Or perhaps its cousin, apixaban?

Currently, answers are still pending as the head-to-head randomized controlled trials comparing apixaban versus rivaroxaban (the COBRA and CANVAS trials) are still being conducted.  In the meantime, let’s quickly review another study comparing apixaban and rivaroxaban that may guide you in the selection of a suitable agent:

          A three-year retrospective cohort study which Published on January 2019 evaluated anticoagulation-naïve patients with new-onset VTE.1 Data were obtained from the US-based Truven Health MarketScan Commercial and Medicare Supplement Claims databases to compare the effectiveness and safety of both rivaroxaban and apixaban in patients with newly-diagnosed VTE.  They found 15,254 patients included in the final cohort (3,091 patients on apixaban and 12,163 patients on rivaroxaban, via propensity-score-matching).  Over the course of an average follow-up period of about 3 months, recurrent VTE was less likely with apixaban vs. rivaroxaban (3 events versus 7 events per 100 person-years).  In addition, major and minor bleeding was less likely with apixaban vs. rivaroxaban (3 events versus 6 events per 100 person-years and 20 versus 34 events per 100 person-years, respectively).  One possible explanation suggested by the authors is that peak -to-trough ratios of rivaroxaban are higher than apixaban (10 versus 3).

Reference:

  1. Dawwas GK et al. Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: A retrospective population-based cohort analysis. Lancet Haematol 2019 Jan; 6:e20.

Raniah Aljadeed, PharmD

PGY2 EM Pharmacy Resident

University of Arizona/ Northwest Medical Center