emDOCs - 52 in 52 – #25 - January 12, 2023 - By Brannon Inman
Reviewed by: Alex Koyfman and Brit Long
Take away:
- Statistically higher odds of ischemic and hemorrhagic events in the rivaroxaban group compared to apixaban.
- Overall, this was an interesting study comparing 2 of the most popular direct oral anticoagulants currently used in the United States.
- It’s not very often you get to see studies comparing one brand name drug to another. Even more interesting is this study was funded by a grant from the national heart lung and blood institute (NHLBI) rather than one of the pharmaceutical companies of interest.
- While the authors utilized a relatively convenient sample of registry patients, this was a large study with hundreds of thousands of patients in each group.
- While the methods were highly selective, they were well outlined in the study.
- There were more patients in the apixaban group than the rivaroxaban group. This resulted in the data having to be adjusted to patient years in order to make meaningful interpretations from the data. With > 100,000 patients in each group, it’s less likely observations are due to chance.
- These are still observational data. The reasons for clinician choice regarding one medication over the other was not captured in this study.
- I would love to see a randomized controlled trial. However, with another registry trial on the horizon looking at the recurrence of DVTs, this will likely be the highest quality evidence we receive on this subject.