Category: Federal Forum Posters
Purpose: The purpose of this study was to compare the safety of rivaroxaban and apixaban in the treatment of venous thromboembolism (VTE) and prevention of stroke in atrial fibrillation at Jesse Brown Veterans Affairs Medical Center (JBVAMC).
Methods: This study was a retrospective, electronic chart review of 200 patients at Jesse Brown Veterans Affairs Medical Center (JBVAMC) with established venous thromboembolism and/or atrial fibrillation who were newly started on rivaroxaban or apixaban therapy during the period between September 1, 2010 and March 31, 2017. The primary endpoint was the composite of major and clinically relevant non-major bleeding. Secondary safety endpoints included the analysis of major bleeding and the analysis of clinically relevant non-major bleeding. Venous thromboembolism recurrence in venous thromboembolism patients and stroke occurrence in atrial fibrillation patients were analyzed as secondary efficacy endpoints.
Results: At baseline, the apixaban group had significantly more patients with an age greater than 65 years (p=0.005), a HAS-BLED score of 5 (p=0.008), and a history of bleeds (p=0.04) compared to the rivaroxaban group. Apixaban showed a 44 percent reduction in the composite primary outcome of major and clinically relevant non-major bleeding compared to rivaroxaban (P=0.049). Likewise, there was a 71 percent reduction in clinically relevant non-major bleeding in the apixaban group compared to rivaroxaban (P=0.007). On the contrary, there was no difference found between groups with respect to the reduction in venous thromboembolism recurrence and stroke.
Conclusion: Apixaban had fewer bleeding events compared to rivaroxaban despite a higher bleeding risk at baseline.
Sharnetria Wright– PGY2 Psychiatric Pharmacy Resident, Jesse Brown VA Medical Center, Chicago, IL