The new research, titled "Apixaban Versus Rivaroxaban in Patients With Atrial Fibrillation and Valvular Heart Disease" published in the Annals of Internal Medicine, reports that atrial fibrillation (AFib) and valvular heart disease (VHD) patients treated with apixaban had a lower risk of stroke or systemic embolism and bleeding compared to patients treated with rivaroxaban.
The Food and Drug Administration (FDA) approves apixaban and rivaroxaban, which are both factor Xa inhibitors, to reduce the risk of stroke and systemic embolism in those with nonvalvular atrial fibrillation. The study compares the efficacy and safety of the two medications in patients with AFib and VHD using data from a large health insurance database.
Apixaban vs. Rivaroxaban
Researchers from the Perelman School of Medicine at the University of Pennsylvania analyzed a total of 19,894 patients divided into two groups, wherein 9,947 received apixaban and another 9,947 received rivaroxaban, MPR reported. Each patient in each group has a counterpart in the other group based on similar characteristics.
Their analysis shows that AFib and VHD patients treated with apixaban experienced a 43% lesser risk of ischemic stroke or systemic embolism, which is greater compared to those treated with rivaroxaban.
Moreover, the rate of ischemic stroke or systemic embolism per patient per year of follow-up to those who received apixaban is about 0.52%, while for rivaroxaban users it was 0.91%.
The team also found that apixaban is associated with a 49% lower risk of gastrointestinal or intracranial bleeding compared to rivaroxaban. On the other hand, they did not find any significant difference between the two agents in all-cause mortality.
Epidemiology Professor Sean Hennessy, PharmD, Ph.D., the study senior author and director of the University of Pennsylvania's Center for Real-world Effectiveness and Safety of therapeutics, said that they believe clinicians should consider their study's findings when selecting an anticoagulant for AFib and VHD patients until further evidence from randomized controlled trials becomes available.
AFib and Valvular Heart Disease (VHD) Explained
According to the Centers for Disease Control and Prevention (CDC), AFib is the most common type of treated heart arrhythmia, a condition when the heart beats too slowly or too fast, or irregularly.
The AFib causes the normal beating of the heart to become irregular in which blood does not flow as well as it should from the atria to the two ventricles in the lower chambers of the heart. It could happen in brief episodes or could be a permanent condition.
Meanwhile, the CDC describes VHD as a disease that occurs when any valve in the heart has been damaged or is diseased. Several causes of VHD are when the mitral valve allows blood to flow from the left atrium to the left ventricle, the tricuspid valve allows blood to flow from the left ventricle to the aorta, and the pulmonary valve allows the blood to flow from the right ventricle to the pulmonary artery.
Both diseases are treated with medication to control the rhythm and rate or to improve symptoms. Lifestyle changes are also recommended for AFib to manage risk factors. However, surgery is done if the AFib or VHD has become severe.
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