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Apixaban Vs Rivaroxaban

Apixaban Vs Rivaroxaban


The more impressive data clearly resides with the Apixaban trial. Announced today, at the European Society of Cardiology meeting (and published simultaneously in the NEJM), the results of the Aristotle trial showed that AF patients that took apixaban (5mg twice daily) suffered significantly fewer strokes and bleeds than those that took warfarin. Most striking though, was that apixaban is the first oral blood thinner that reduced the risk of death from any cause. (For more on the specifics of Aristotle, I refer you to Larry Husten’s concise summary on Cardiobrief, and Ms Sue Hughes’ piece on


Earlier this month, the ROCKET-AF trial (NEJM) reported that patients that took rivaroxaban 20mg once daily had fewer strokes and intracranial bleeds than those who took warfarin. Here though, the data are cloudier than the apixaban (and dabigatran (RE-LY) trial)). It’s mathematically complicated, but suffice to say that rivaroxaban can only be called non-inferior, not superior, to warfarin. Further, the risk of overall bleeding with rivaroxaban was the same—not less.


Medication non-adherence can result in poor health outcomes. Understanding differences in adherence rates to non-vitamin K oral anticoagulants (NOACs) could guide treatment decisions and improve clinical outcomes among patients with non-valvular atrial fibrillation (NVAF).

Missed doses

1. ApixabanIf

a dose is missed, the patient should take theapixaban immediately and then continue withtwice daily intake as before.

2. Rivaroxaban

If a dose is missed during the 15 mg twice dailytreatment phase (day 1 - 21), the patient shouldtake the missed dose immediately and take thenext dose on time (if the next dose is due two 15mg tablets can be taken together). The patientshould then continue with 15 mg twice daily.If a dose is missed during the once daily treatmentphase (day 22 and onwards), the patient shouldtake the missed doseimmediately, and continueon the following day with the once daily intake asrecommended. The dose should not be doubled within the same day to make up for a missed dose.


The use of factor Xa inhibitors is notrecommended in patients receiving concomitant systemic treatmentwith azole-antimycotics (suchas ketoconazole, itraconazole, voriconazole andposaconazole) or HIV protease inhibitors (such asritonavir). These active substances are stronginhibitors of both CYP3A4 and P-gp and thereforemay increase apixaban and rivaroxaban plasmaconcentrations to a clinically relevant degree. Coadministrationof factor Xa inhibitors with strongCYP3A4 inducers e.g. rifampicin, phenytoin,carbamazepine, phenobarbital or St. John’s Wort,may lead to reduced apixaban and rivaroxabanplasma concentrations. We therefore recommend that strong CYP3A4 inducers should not be coadministeredwith factor Xa inhibitors whentreating acute venous thromboembolism.Macrolide antibiotics, such as clarithromycin anderythromycin, may inhibit metabolism of factor Xainhibitors and therefore caution should be appliedif co-prescribed. Co-administration of rivaroxabanwith dronedarone should be avoided given limitedclinical data. Care should also be taken if patientsare treated concomitantly with medicinal productsaffecting haemostasis.


Common side effects of Eliquis include:

  • skin rash,
  • allergic reactions,
  • fainting, nausea, and
  • anemia.

Xarelto vs Eliquis vs Pradaxa vs Savaysa – Which Should You Choose?


In a previous post we talked about the fact that NOACs make a lot of people uneasy, even though the data suggests that they’re often the better choice for afib patients.

And making the right choice can be difficult, since nobody’s really taken the time to sit down and line it all up: how each drug compares to all of the other drugs. In fact, sometimes even doctors aren’t sure which one to prescribe.

ConclusionsIn patients with nonvalvular atrial fibrillation, apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin.

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