Evidence map›Paper›PMID 39154873›Full record

ArticleHeart rhythm2025

Apixaban vs rivaroxaban in patients with atrial fibrillation at high or low bleeding risk: A population-based cohort study.

Mohammed Shurrab, Peter C Austin, Cynthia A Jackevicius, Karen Tu, Feng Qiu, Olivia Haldenby, Steven Davies, Renato D Lopes, Tina Baykaner, Linda S Johnson and 2 more

Abstract readMulticenter StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart rhythm, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

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

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Outcomes of individual DOACs vs. VKAs in AF patients with frailty: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  6. Article
  7. Article
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

12 authors.

Mohammed ShurrabCardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada; Health Sciences North Research Institute, Sudbury, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto and North, Ontario, Canada; Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: shurrabm@hotmail.com.
Peter C AustinInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto and North, Ontario, Canada.
Cynthia A JackeviciusInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto and North, Ontario, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California; Pharmacy Department, VA Greater Los Angeles Healthcare System, California.
Karen TuInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, and University Health Network-Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada.
Feng QiuICES, Toronto and North, Ontario, Canada.
Olivia HaldenbyICES, Toronto and North, Ontario, Canada.
Steven DaviesCardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
Renato D LopesDuke University Medical Center, Durham, North Carolina.
Tina BaykanerDepartment of Medicine, Stanford University, Stanford, California.
Linda S JohnsonDepartment of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Population Health Research Institute, Hamilton, Ontario, Canada.
Jeff S HealeyDivision of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
Dennis T KoInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto and North, Ontario, Canada; Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Funding

Deep Neural Networks To Treat Atrial FibrillationK23HL145017 · NHLBI · STANFORD UNIVERSITY · PI BAYKANER, TINA · 2019 to 2023
$968k
NHLBI NIH HHS K23 HL145017
6 · The paper itself

Abstract

backgroundDespite many atrial fibrillation (AF) patients being at risk of bleeding, very limited data are available on bleeding rates of different direct oral anticoagulants based on the spectrum of bleeding risk.

objectiveWe aimed to compare the risk of major bleeding and thromboembolic events with apixaban vs rivaroxaban for AF patients stratified by bleeding risk.

methodsWe conducted a population-based, retrospective cohort study of all adult patients (66 years or older) with AF in Ontario, Canada, who were treated with apixaban or rivaroxaban between April 1, 2011, and March 31, 2020. Bleeding risk was estimated by the HAS-BLED score, with high bleeding risk defined as a score of ≥3. The primary safety outcome was major bleeding, and the primary efficacy outcome was thromboembolic events. Comparisons were adjusted for baseline comorbidities by inverse probability of treatment weighting.

resultsThis study included 18,156 AF patients with high bleeding risk and 55,186 AF patients with low bleeding risk. Apixaban use was more common in patients with high bleeding risk; 63% of high-risk patients used apixaban compared with 56% of low-risk patients. Apixaban users had lower rates of major bleeding in high-risk patients (2.9% vs 4.2% per year; hazard ratio [HR], 0.69; 95% CI, 0.58-0.81) and in low-risk patients (1.8% vs 2.9% per year; HR, 0.63; 95% CI, 0.56-0.70) compared with rivaroxaban. There were no differences in rates of thromboembolic events, 3.1% vs 3.0% per year (HR, 1.02; 95% CI, 0.86-1.22) in high-risk patients and 1.9% vs 1.9% per year (HR, 1.00; 95% CI, 0.89-1.14) in low-risk patients.

conclusionIn older AF patients with high or low bleeding risk, treatment with apixaban was associated with lower rates of major bleeding with no difference in risk for thromboembolic events compared with rivaroxaban.

Indexed as

Atrial FibrillationHemorrhagePyrazolesPyridonesRivaroxabanStrokeThromboembolismAgedFactor Xa InhibitorsFemaleFollow-Up StudiesHumansIncidenceMaleOntarioRetrospective StudiesapixabanFactor Xa InhibitorsPyrazolesPyridonesRivaroxabanApixabanAtrial fibrillationBleedingHigh or low bleeding riskRivaroxabanThromboembolic events

Identifiers

PMID39154873
PMCPMC12184086

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.