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Bleeding rates of Veterans taking apixaban or rivaroxaban for atrial fibrillation or venous thromboembolism

  • Zachary HoweEmail author
  • Chad Naville-Cook
  • Derek Cole
Article
  • 169 Downloads

Abstract

This study examined potential differences in bleeding between apixaban and rivaroxaban, the most commonly utilized direct oral anticoagulants at the Richard L. Roudebush VA Medical Center. Additionally, the analysis included a comparison between observed and literature-reported bleeding rates. This retrospective chart review examined 452 (39%) Veterans receiving rivaroxaban and 716 (61%) Veterans receiving apixaban. Bleeding rates were expressed per 100 patient-years and the overall rates were analyzed as the primary analysis. Secondary objectives included comparisons based on indication and severity, as well as comparisons to literature-reported bleed rates, time to bleeding event, and location of the bleed. The analysis did not detect any statistically significant differences between apixaban and rivaroxaban in terms of overall, (ARR 0.90% per 100 patient-years, 95% CI − 0.58 to 2.38%, p > 0.05) major, (ARR 0.22% per 100 patient-years, 95% CI − 0.74 to 1.17%, p > 0.05) or non-major clinically relevant (ARR 0.35% per 100 patient-years, 95% CI − 0.57 to 1.27%, p > 0.05) bleeding. Observed bleeding for both rivaroxaban and apixaban in the Veteran population exceeded the rates reported by the literature when used for atrial fibrillation (1.96% vs. 0.15%, p < 0.05; 1.08% vs. 0.16%, p < 0.05) but the opposite was seen for long term venous thromboembolism (VTE) treatment (3.97% vs. 8.03%, p < 0.0001; 0.14% vs. 15.51%, p < 0.0001) or extended VTE prophylaxis (0.07% vs 5.98%, p < 0.0001; 0.07% vs 1.88%, p < 0.01). Results from this study suggest these agents impart similar levels of risk, but variations in bleeding risk between the Veteran population and the patients in the original clinical trials may exist.

Keywords

Direct oral anticoagulants (DOAC) Novel oral anticoagulants (NOAC) Veterans affairs Apixaban Rivaroxaban 

Notes

Acknowledgements

We would like to thank Andrea Kingsolver, PharmD and the members of the Pharmacy Therapeutics Workgroup at the Richard L Roudebush VA Medical Center for assistance with manuscript editing and study facilitation, respectively. This material is the result of work supported with resources and the use of facilities at the Richard L Roudebush VA Medical Center, Indianapolis, IN. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Compliance with ethical standards

Conflict of interest

The author(s) declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Supplementary material

11239_2018_1770_MOESM1_ESM.pdf (136 kb)
Supplementary material 1 (PDF 135 KB)
11239_2018_1770_MOESM2_ESM.pdf (134 kb)
Supplementary material 2 (PDF 133 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pharmacy ServiceRichard L. Roudebush VA Medical CenterIndianapolisUSA
  2. 2.Butler University College of Pharmacy and Health SciencesIndianapolisUSA

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