Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation.

Deitelzweig, Steven, Kang, Amiee, Jiang, Jenny, Gao, Chuan, Luo, Xuemei, Atreja, Nipun, Han, Stella, Cheng, Dong, Loganathan, Saarusri R and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2024) Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation. Journal of clinical medicine, 13 (4). p. 1073.

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Official URL: http://dx.doi.org/10.3390/jcm13041073

Abstract

<h4>Background</h4>Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants.<h4>Methods</h4>Using Optum's de-identified Clinformatics® Data Mart Database, we identified NVAF patients initiating apixaban or rivaroxaban between 1 January 2013 and 31 December 2021. Patients switching therapies within 30 days before or 90 days after discontinuing their initial DOAC and those who continued initial therapy were included. The index date was the switch date for switchers, while continuers were assigned a hypothetic index date. Switchers and continuers were propensity score matched based on pre-index characteristics.<h4>Results</h4>Among 167,868 apixaban and 65,888 rivaroxaban initiators, 2900 apixaban-to-rivaroxaban switchers were matched with 14,500 apixaban continuers, and 2873 rivaroxaban-to-apixaban switchers were matched with 14,365 rivaroxaban continuers. Apixaban-to-rivaroxaban switching was associated with higher stroke/SE risk (HR: 1.99, 95% CI: 1.38-2.88) and MB risk (HR:1.80, 95% CI: 1.46-2.23) than continuing apixaban. Rivaroxaban-to-apixaban switching had similar stroke/SE risk (HR: 0.74, 95% CI: 0.45-1.22) but lower MB risk (HR: 0.49, 95% CI: 0.38-0.65) than continuing rivaroxaban.<h4>Conclusions</h4>These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban.

Item Type:	Article
Uncontrolled Keywords:	direct oral anticoagulants, major bleeding, non-valvular atrial fibrillation, real world, stroke, switching
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	29 Feb 2024 09:06
Last Modified:	29 Feb 2024 09:07
DOI:	10.3390/jcm13041073
Open Access URL:	https://doi.org/10.3390/jcm13041073
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178985