Trial reportAnnals of internal medicine2022
Apixaban Versus Rivaroxaban in Patients With Atrial Fibrillation and Valvular Heart Disease : A Population-Based Study.
Trial report in Annals of internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review.JAMA network open · 2023Pooled it
- Methodological Concerns Regarding a Recent Meta-Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists in Non-Valvular Atrial Fibrillation.Clinical cardiology · 2026Article
- Bleeding and thrombotic outcomes with oral anticoagulants in patients with inflammatory bowel disease and venous thromboembolism.Blood advances · 2026Article
- Design and Implementation of Observational Studies Emulating a Target Trial.JAMA network open · 2026Article
- Effectiveness and safety of rivaroxaban vs. apixaban in patients with atrial fibrillation and peripheral artery disease.European heart journal. Cardiovascular pharmacotherapy · 2025Observational
- Non-Vitamin K Antagonist Oral Anticoagulants for Thromboembolic Prevention in Patients with Atrial Fibrillation and Concomitant Mitral Stenosis: A Retrospective Observational Study.Acta Cardiologica Sinica · 2025Article
- Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature.Annals of medicine and surgery (2012) · 2025Review
- Review
- Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves.Journal of the American Heart Association · 2025Article
- Comparative effectiveness and safety of rivaroxaban with other oral anticoagulants in older adults with nonvalvular atrial fibrillation: population-based analysis in response to updated Beers Criteria.Journal of thrombosis and haemostasis : JTH · 2025Article
- Optimizing Anticoagulation in Valvular Heart Disease: Navigating NOACs and VKAs.Journal of personalized medicine · 2024Review
- Review
- Comparative Safety and Effectiveness of Warfarin or Rivaroxaban Versus Apixaban in Patients With Advanced CKD and Atrial Fibrillation: Nationwide US Cohort Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024Article
- New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States.Age and ageing · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAlthough apixaban and rivaroxaban are commonly used in patients with atrial fibrillation (AF) and valvular heart disease (VHD), there is limited evidence comparing the 2 drugs in these patients.
objectiveTo emulate a target trial of effectiveness and safety of apixaban and rivaroxaban in patients with AF and VHD.
designNew-user, active comparator, cohort study design.
settingCommercial health insurance database from 1 January 2013 to 31 December 2020. PATIENTS: New users of apixaban or rivaroxaban who had a diagnosis of AF and VHD before initiation of anticoagulant therapy. MEASUREMENTS: The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of gastrointestinal or intracranial bleeding. Cox proportional hazards regression with a robust variance estimator was used to estimate hazard ratios (HRs) and 95% CIs.
resultsWhen compared with rivaroxaban in a propensity score-matched cohort of 19 894 patients (9947 receiving each drug), apixaban was associated with a lower rate of ischemic stroke or systemic embolism (HR, 0.57 [95% CI, 0.40 to 0.80]) and bleeding (HR, 0.51 [CI, 0.41 to 0.62]). The absolute reduction in the probability of stroke or systemic embolism with apixaban compared with rivaroxaban was 0.0026 within 6 months and 0.011 within 1 year of treatment initiation. The absolute reduction in the probability of bleeding events with apixaban compared with rivaroxaban was 0.012 within 6 months and 0.019 within 1 year of treatment initiation. LIMITATION: Short follow-up time and inability to ascertain some types of VHD.
conclusionIn this study of patients with AF and VHD, patients receiving apixaban had a lower risk for ischemic stroke or systemic embolism and for bleeding when compared with those receiving rivaroxaban. PRIMARY FUNDING SOURCE: National Institutes of Health.
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