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Observational studies and indirect comparisons have suggested a lower bleeding risk with the direct-acting oral anticoagulant (DOAC) apixaban compared to rivaroxaban. Now, researchers report the results of a head-to-head trial, the first to compare two DOACs, evaluating the bleeding risks of these two drugs.
In this open-label, multisite study, 2800 patients (average age, 58) with acute deep vein thrombosis or pulmonary embolism were randomized to receive apixaban or rivaroxaban.
During 3 months of follow-up, the composite outcome of major bleeding plus clinically relevant minor bleeding was twice as likely with rivaroxaban as with apixaban (7.1% vs. 3.3%; number needed to harm, 26). Much of this 4 percentage-point differenc…