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Thromb Haemost 2022; 122(10): 1794-1803
DOI: 10.1055/a-1798-2116
Stroke, Systemic or Venous Thromboembolism

Effectiveness and Safety of Apixaban versus Rivaroxaban in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus

Krishna Roy Chowdhury
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
2   Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
,
Jonathan Michaud
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
,
Oriana Hoi Yun Yu
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
3   Division of Endocrinology, Jewish General Hospital, Montreal, Québec, Canada
,
Hui Yin
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
,
Laurent Azoulay 
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
2   Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
4   Gerald Bronfman Department of Oncology, McGill University, Montreal, Québec, Canada
,
Christel Renoux 
1   Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
2   Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
5   Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
› Author Affiliations Funding None.
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Abstract

Aims To evaluate the effectiveness and safety of apixaban versus rivaroxaban among patients with nonvalvular atrial fibrillation (NVAF) and type 2 diabetes mellitus (T2DM).

Methods and Results Using the United Kingdom's Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository, and the Office for National Statistics database, we identified a cohort of patients with NVAF and T2DM newly treated with apixaban or rivaroxaban between 2013 and 2020. Propensity scores with standardized mortality ratio weighting were used to control for confounding. We used weighted Cox proportional hazards models to estimate separately the hazard ratios (HRs) with 95% confidence intervals (CIs) of ischemic stroke, major bleeding, and major adverse limb events associated with the use of apixaban compared with rivaroxaban. We also evaluated whether the risk was modified by age, sex, duration of diabetes, microvascular and macrovascular complications of diabetes, nephropathy, CHA2DS2-VASc and HAS-BLED scores, and by dose (standard vs. low dose).

Results The cohort included 11,561 apixaban and 8,265 rivaroxaban users. Apixaban was associated with a similar risk of stroke (HR: 0.99, 95% CI: 0.79–1.23), and a 32% reduced risk of major bleeding (HR: 0.68, 95% CI: 0.59–0.78), compared with rivaroxaban. The risk of major adverse limb events was similar between apixaban and rivaroxaban (HR: 0.75, 95% CI: 0.54–1.04). Overall, the risk of ischemic stroke and major bleeding was consistent in stratified analyses.

Conclusion Among patients with NVAF and T2DM, apixaban was associated with a similar risk of stroke and a lower risk of major bleeding compared with rivaroxaban.

Keywords

nonvalvular atrial fibrillation - type 2 diabetes - apixaban - rivaroxaban - bleeding - stroke

Supplementary Material



Publication History

Received: 10 December 2021

Accepted: 13 March 2022

Accepted Manuscript online:
15 March 2022

Article published online:
13 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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