Real-World Evidence in Anticoagulation of Atrial Fibrillation

Head-to-head comparisons of individual direct-acting oral anticoagulants (DOACs) for their efficacy and safety in preventing stroke in atrial fibrillation (AF) are lacking. The current retrospective, active-comparator cohort study compared outcomes between new users of apixaban versus rivaroxaban in a population with AF and valvular heart disease. Data were from a commercial health insurance database. Patients with prior anticoagulation or stroke and those on dialysis were excluded.

In a propensity-score–matched cohort of nearly 10,000 patients on each drug, apixaban was associated with a 43% lower rate of ischemic stroke or systemic thromboembolism and a 49% lower rate of bleeding compared with rivaroxaban. The absolute reduction in the pro…