Effectiveness and safety of rivaroxaban vs apixaban in patients with Atrial Fibrillation and Peripheral Artery Disease
Bibliographic record
Abstract
Abstract Background/Introduction Peripheral artery disease (PAD) increases the risk of stroke, cardiovascular death, and major adverse limb events (MALE) in patients with atrial fibrillation (AF). However, the effectiveness and safety of rivaroxaban compared with apixaban in patients with both NVAF and PAD is unclear, especially for MALE, a critical outcome in PAD. Purpose To compare the effectiveness and safety of rivaroxaban versus apixaban in patients with NVAF and PAD. Methods Using the UK Clinical Practice Research Datalink, a large primary care database, we formed a cohort of patients aged ≥45 years with incident NVAF and PAD who initiated rivaroxaban or apixaban between 2013 and 2021. Cohort entry was defined as the first prescription for rivaroxaban or apixaban following NVAF diagnosis. The primary effectiveness outcomes were MALE, defined as hospitalization for acute limb ischemia or major amputation, and a composite of ischemic stroke, transient ischemic attack (TIA), or systemic embolism (SE). The primary safety outcome was major bleeding defined as bleeding requiring hospitalization or resulting in death. We used propensity score fine stratification and weighting for confounding control. We fit weighted Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome associated with rivaroxaban compared with apixaban. Results The cohort included 6,170 new-users of rivaroxaban and 9,990 new-users of apixaban. Rivaroxaban and apixaban had similar incidence rates of MALE (adjusted rates 6.7 vs. 5.6 per 1,000 person-years; adjusted HR (aHR) 1,20; 95% CI 0.87-1.65) and stroke/TIA/SE (adjusted rates 24.5 vs. 21.3 per 1,000 person-years; aHR 1,15; 95% CI 0.97-1.36). Major bleeding rates were higher with rivaroxaban (adjusted rates 46.1 vs. 29.8 per 1,000 person-years; aHR 1,55; 95% CI 1.36-1.77). The risk remained higher for all bleeding sites (intracranial hemorrhage: (HR 1.65; 95% CI 1.03-2.66), gastro-intestinal bleeding: (HR 1.52; 95% CI 1.17-1.98) and other bleeding: (HR 1.59; 95% CI 1.22-2.08)) Conclusion In patients with NVAF and PAD, rivaroxaban and apixaban showed similar effectiveness for preventing MALE and stroke/TIA/SE. However, rivaroxaban was associated with a higher risk of major bleeding. These findings support apixaban as a potentially safer anticoagulant in this high-risk population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".