Apixaban Lowers GI Bleeding Risk in Patients With Atrial Fibrillation

Apixaban use in individuals with atrial fibrillation (AF) was associated with a lower risk of gastrointestinal bleeding when compared with other direct oral anticoagulants (DOACs), according to the results of a multinational population-based cohort study.

The researchers compared apixaban, dabigatran, edoxaban, and rivaroxaban, on rates of ischemic stroke or systemic embolism, intracranial hemorrhage (ICH), gastrointestinal bleeding, and all-cause mortality.

Reseachers utilized patient data from five electronic health care databases in France, German, the United Kingdom, and the United States. To be included, participants must have been newly diagnosed with AF and have received a new DOAC prescription from 2010 to 2019. Of the 527,226 total patients, apixaban was prescribed to 281,320 participants, dabigatran to 61,008 patients, edoxaban to 12,722 patients, and rivaroxaban to 172,176 patients.

The results indicated that apixaban was associated with a lower risk of gastrointestinal bleeding than dabigatran (HR 0.81; 95% CI: 0.70 - 0.94), edoxaban (HR 0.77; 95% CI: 0.66 - 0.91), and rivaroxaban (HR 0.72; 95% CI: 0.66 - 0.79). However, apixaban did not lower the risk of the other outcomes when compared with other DOACs. 

Further, these associations were consistent between lower gastrointestinal bleed risk and apixaban use vs rivaroxaban among patients receiving the standard dose (HR 0.72; 95% CI: 0.64 - 0.82) and those receiving a reduced dose (HR 0.68; 95% CI: 0.59 - 0.77.)

“Among patients with AF, apixaban use was associated with lower risk for gastrointestinal bleeding and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban,” the researchers concluded. “This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinica trials.”


—Leigh Precopio



Lau WCY, Torre CO, Man KKC, et al. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation. Ann Intern Med. Published online November 1, 2022.