Researchers in the University of Florida College of Pharmacy led the first population-based cohort study to examine the effectiveness and safety of apixaban, a novel agent, compared to rivaroxaban in patients with venous thromboembolism. Published in the Lancet Hematology, an online journal with an impact factor of 10.7, the study provides new information that will impact the selection of treatment for patients with venous thromboembolism.
Although warfarin has been the drug of choice for decades, because of some constraints associated with its use, direct-acting oral anticoagulants such as rivaroxaban and apixaban are increasingly being used in routine clinical practice because of their conventional dosing and favorable pharmacological profiles. However, evidence regarding its effectiveness and safety of these direct-acting oral anticoagulants in patients with venous thromboembolism remains limited.
The study of approximately 15,254 patients found a lower risk of recurrent venous thromboembolism, major bleeding events, and minor bleeding events with the use of apixaban compared to rivaroxaban. The benefits of apixaban remained consistent in selected subgroups of the venous thromboembolism population, including those with chronic kidney disease and active cancer.
Results from two head-to-head randomized controlled trials comparing apixaban and rivaroxaban, COBRA and CANVAS trials, which are still recruiting participants, are expected in the future; until these results become available, evidence generated from this study can help to guide selection between apixaban and rivaroxaban in clinical practice. UF College of Pharmacy researchers who led the study include Ghadeer Dawwas, M.B.A., Haesuk Park, Ph.D., Eric Dietrich, Pharm.D., and Josh Brown, Ph.D.