Efficacy and safety of apixaban versus rivaroxaban in acute venous thromboembolism: a systematic review and meta-analysis.
Shaheer Bin Shafiq, Muhammad Hassan, Areeba Memon et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared apixaban with rivaroxaban for acute venous thromboembolism in adults. Thirteen studies included 233,569 participants; most evidence was observational, with one randomised trial. Recurrent VTE was not significantly different (RR 0.82, 95% CI 0.64-1.05). Apixaban was associated with lower major bleeding (RR 0.75, 95% CI 0.57-0.99), clinically relevant non-major bleeding, and gastrointestinal bleeding. Overall, efficacy appeared broadly comparable, while bleeding outcomes may favour apixaban; certainty was low to very low.
Key findings
- Recurrent VTE did not differ significantly: RR 0.82, 95% CI 0.64-1.05.
- Major bleeding was lower with apixaban: RR 0.75, 95% CI 0.57-0.99.
- Apixaban was associated with lower CRNMB (RR 0.63, 95% CI 0.53-0.75) and gastrointestinal bleeding (RR 0.68, 95% CI 0.62-0.75).
- Recurrent DVT was lower with apixaban (RR 0.88, 95% CI 0.79-0.98); recurrent PE and all-cause mortality did not differ significantly.
Why it matters
Comparative anticoagulant evidence can inform assessment of efficacy and bleeding trade-offs in acute VTE. This analysis suggests similar overall protection against recurrent VTE, with bleeding outcomes that may favour apixaban. However, the predominance of observational studies and low-to-very-low certainty mean the apparent safety differences should be interpreted cautiously rather than treated as definitive comparative effects.
What to keep in mind
Most evidence was observational, heterogeneity was present, and certainty ranged from low to very low; only one randomised clinical trial contributed.