Primary outcomes included all-cause hospitalization, stroke and major bleeding, stroke and systemic embolism.

Overall, the authors found that the adjusted hazard ratio from the meta-regression analyses was 0.88 to 0.95, indicating a significantly lower hazard of stroke/systemic embolism associated with apixaban compared with rivaroxaban.

The authors also found that pair-wise meta-analyses showed that the pooled hazards of a major bleeding episode were significantly lower with apixaban than rivaroxaban. However, apixaban was also associated with a lower risk of gastrointestinal bleeding than rivaroxaban.  

There was no significant difference in ischemic stroke between the two DOACs. 

However, apixaban was associated with a notably lower risk of hemorrhagic stroke than rivaroxaban.

“The findings from this summary of evidence demonstrate that apixaban is associated with lower rates of both major and gastrointestinal bleeding than rivaroxaban, with no loss of efficacy, which corroborates recent direct and indirect comparisons between the treatments,” the authors wrote. 

Read the full study here.

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