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![Decisions regarding thromboprophylaxis requires weighing the risk of stroke against the risk of bleeding in each patient.[3,4] Numerous risk assessment tools are available, including CHADS2, CHA2DS2-VASc, and HAS-BLED. American and European guidelines recommend the use of CHA2DS2-VASc, which considers sex, age, and history of congestive HF, hypertension, stroke/transient ischemic attack/thromboembolism, vascular disease, and diabetes mellitus.[3,4] Compared with other stroke risk assessment measures, this tool performed best in identifying patients at low risk of stroke who did not require anticoagulation therapy.[12] Oral anticoagulation is recommended in any patient with a score ≥2 on the CHA2DS2-VASc. In these patients, warfarin or the novel anticoagulants dabigatran, rivaroxaban, apixaban, or edoxaban can be considered, except in the setting of moderate to severe chronic kidney disease, where reduced doses of direct thrombin or factor Xa inhibitors are preferable.[4]](https://www.thecardiologyadvisor.com/wp-content/uploads/sites/17/2019/01/slideshowsizeatrialfibrillati_1061315.jpg)
HealthDay News — Among adults with atrial fibrillation, the rates for ischemic stroke or systemic embolism and bleeding are lower with apixaban compared with rivaroxaban, according to a study published online March 10 in the Annals of Internal Medicine.
Michael Fralick, M.D., Ph.D., from Brigham and Women’s Hospital in Boston, and colleagues compared the safety and effectiveness of apixaban versus rivaroxaban for patients with nonvalvular atrial fibrillation. A total of 39,351 patients newly prescribed apixaban were propensity score-matched with 39,351 patients who were newly prescribed rivaroxaban; patients were followed for a mean of 288 and 291 days, respectively.
The researchers found that the incidence rate of ischemic stroke or systemic embolism was 6.6 and 8.0 per 1,000 person-years for those prescribed apixaban and rivaroxaban, respectively (hazard ratio, 0.82). Compared with those prescribed rivaroxaban, those prescribed apixaban had a lower rate of gastrointestinal bleeding or intracranial hemorrhage (12.9 versus 21.9 per 1,000 person-years; hazard ratio, 0.58).
“Apixaban may be safer and more effective than rivaroxaban for treating nonvalvular atrial fibrillation,” the authors write. “Until head-to-head clinical trial data are available, the results of our study, which included a large sample of patients seen in routine care, [provide] updated evidence in support of apixaban for treating nonvalvular atrial fibrillation.”
Several authors disclosed financial ties to the pharmaceutical industry.
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