The Daily Dose: Dueling DOACS

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On October 19, 2022, we reviewed a study published in Annals of Internal Medicine, that was the first to directly compare the efficacy and safety of the factor Xa inhibitors apixaban and rivaroxaban in a population with atrial fibrillation (AF) and valvular heart disease (VHD).

The study

To emulate a clinical trial of the 2 drugs’ safety and efficacy, investigators designed a new-user, active comparator cohort study using commercial health insurance claims data from the Optum Clinformatics Data Mart database from January 1, 2013-December 31, 2020. The researchers identified individuals with diagnoses of AF and VHD who had a first-recorded prescription for apixaban or rivaroxaban during the prescribed period. Efficacy was assessed based on a composite outcome of ischemic stroke or systemic embolism and safety on a composite of gastrointestinal or intracranial bleeding.

Patients treated with apixaban had a 43% lower risk of the composite primary efficacy endpoint and a nearly 50% lower risk for bleeding compared with rivaroxaban-treated patients.

Clinical implications

The 2 direct oral anticoagulants are the most frequently prescribed for this patient population, but before this study no investigational comparisons had been made. "Until evidence from randomized controlled trials becomes available, we believe clinicians should consider our findings when selecting anticoagulants in patients with AF and VHD,” the authors concluded.

Click here for the full study review.