Evidence map›Paper›PMID 38976880›Full record

ArticleAnnals of internal medicine2024

Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation : A Nationwide Cohort Study.

Tracey G Simon, Daniel E Singer, Yichi Zhang, Julianna M Mastrorilli, Alexander Cervone, Elyse DiCesare, Kueiyu Joshua Lin

Registry-linked trialAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07521332 (Apixaban Plus Carvedilol to Prevent Portal Hypertension Complications in Cirrhosis), which is not on this map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT07521332 phase4recruitingnot on this mapstarted 2026, after this paper: background citation

Apixaban Plus Carvedilol to Prevent Portal Hypertension Complications in Cirrhosis: A Randomized Single-Blind Placebo-Controlled Trial at AIMS, Hyderabad, Pakistan

TypeinterventionalSponsorAsian Institute Of Medical SciencesRan2026 to 2028Enrolled220ConditionsCirrhosis, Esophageal and Gastric Varices, Ascites, Hepatic EncephalopathyArmsApixaban, Carvedilol, Placebo
3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Comparison of the Efficacy and Safety of Direct Oral Anticoagulants and Warfarin in Cirrhotic Patients: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
  7. Review
  8. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2024.European heart journal. Cardiovascular pharmacotherapy · 2025
    Review
  9. Article
  10. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Tracey G SimonDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; Division of Gastroenterology and Hepatology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School; and Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, Massachusetts (T.G.S.).ORCID 0000-0003-0610-5287
Daniel E SingerDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (D.E.S.).ORCID 0000-0001-6145-4848
Yichi ZhangDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Y.Z., J.M.M., A.C., E.D.).ORCID 0000-0003-4885-9028
Julianna M MastrorilliDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Y.Z., J.M.M., A.C., E.D.).
Alexander CervoneDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Y.Z., J.M.M., A.C., E.D.).
Elyse DiCesareDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Y.Z., J.M.M., A.C., E.D.).
Kueiyu Joshua LinDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (K.J.L.).ORCID 0000-0003-4564-3715

Funding

The Comparative Effectiveness and Safety of Oral Anticoagulants in Patients with Cirrhosis and Atrial FibrillationR01HL167021 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Tracey Simon · 2023 to 2026
$3.4M
Effectiveness and Safety of Transcatheter Left Atrial Appendage Occlusion vs. Anticoagulation in Older Adults with Atrial Fibrillation and Alzheimer's Disease and Related dementiasR01AG075335 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI LIN, JOSHUA K · 2022 to 2025
$3.0M
NHLBI NIH HHS R01 HL167021NIA NIH HHS R01 AG075335
6 · The paper itself

Abstract

backgroundApixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events, albeit with increased bleeding risk, among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF.

objectiveTo compare the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF.

designPopulation-based cohort study.

settingTwo U.S. claims data sets (Medicare and Optum's de-identified Clinformatics Data Mart Database [2013 to 2022]).

participants1:1 propensity score (PS)-matched patients with cirrhosis and nonvalvular AF initiating use of apixaban, rivaroxaban, or warfarin. MEASUREMENTS: Primary outcomes included ischemic stroke or systemic embolism and major hemorrhage (intracranial hemorrhage or major gastrointestinal bleeding). Database-specific and pooled PS-matched rate differences (RDs) per 1000 person-years (PY) and Cox proportional hazard ratios (HRs) with 95% CIs were estimated, controlling for 104 preexposure covariates.

resultsRivaroxaban initiators had significantly higher rates of major hemorrhagic events than apixaban initiators (RD, 33.1 per 1000 PY [95% CI, 12.9 to 53.2 per 1000 PY]; HR, 1.47 [CI, 1.11 to 1.94]) but no significant differences in rates of ischemic events or death. Consistently higher rates of major hemorrhage were found with rivaroxaban across subgroup and sensitivity analyses. Warfarin initiators also had significantly higher rates of major hemorrhage than apixaban initiators (RD, 26.1 per 1000 PY [CI, 6.8 to 45.3 per 1000 PY]; HR, 1.38 [CI, 1.03 to 1.84]), particularly hemorrhagic stroke (RD, 9.7 per 1000 PY [CI, 2.2 to 17.2 per 1000 PY]; HR, 2.85 [CI, 1.24 to 6.59]). LIMITATION: Nonrandomized treatment selection.

conclusionAmong patients with cirrhosis and nonvalvular AF, initiators of rivaroxaban versus apixaban had significantly higher rates of major hemorrhage and similar rates of ischemic events and death. Initiation of warfarin versus apixaban also contributed to significantly higher rates of major hemorrhagic events, including hemorrhagic stroke. PRIMARY FUNDING SOURCE: National Institutes of Health.

Indexed as

AnticoagulantsAtrial FibrillationFactor Xa InhibitorsHemorrhageLiver CirrhosisPyrazolesPyridonesRivaroxabanWarfarinAgedCohort StudiesEmbolismFemaleHumansIschemic StrokeMaleAnticoagulantsapixabanFactor Xa InhibitorsPyrazolesPyridonesRivaroxabanWarfarin

Identifiers

PMID38976880
PMCPMC11671173

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.