WEDNESDAY, Oct. 19, 2022 (HealthDay News) — For patients with atrial fibrillation (AF) and valvular heart disease (VHD), apixaban is associated with a reduced risk for ischemic stroke or systemic embolism and a reduced risk for bleeding compared with rivaroxaban, according to a study published online Oct. 18 in the Annals of Internal Medicine.

Ghadeer K. Dawwas, Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues emulated a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD in a new-user cohort study. Data were obtained from a commercial health insurance database from Jan. 1, 2013, to Dec. 31, 2020.

The researchers found that apixaban was associated with a lower rate of ischemic stroke or systemic embolism (hazard ratio, 0.57) and bleeding (hazard ratio, 0.51) compared with rivaroxaban in a propensity score-matched cohort of 19,894 patients (9,947 receiving each drug). The absolute reduction in the probability of stroke or systemic embolism with apixaban versus rivaroxaban was 0.0026 and 0.011 within six months and one year of treatment initiation, respectively. The corresponding absolute reductions in the probability of bleeding events were 0.012 and 0.019.

“Patients with AF and VHD who were new users of apixaban had a lower risk for ischemic stroke or systemic embolism and a lower risk for bleeding compared with rivaroxaban,” the authors write. “Until evidence from randomized controlled trials become available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AF and VHD.”

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