Background

Direct-acting oral anticoagulants (DOACs) including rivaroxaban and apixaban are preferred over vitamin K antagonists for the treatment of venous thromboembolism (VTE). We conducted a systematic review and a meta-analysis to compare the efficacy and safety of rivaroxaban versus apixaban in the treatment of VTE.

Methods

We conducted an electronic search for studies that directly compared treatment with rivaroxaban and apixaban in adult patients with VTE. The relative risks (RRs) and 95% confidence intervals (CIs) were estimated and pooled using a fixed-effect model unless significant heterogeneity was present (I² > 40%), then random-effects model was used. The primary efficacy and safety outcomes were recurrent VTE (rVTE) and major bleeding events, respectively.

Results

Nine observational studies were included in our meta-analysis, assessing 24,156 patients for apixaban and 38,847 for rivaroxaban. Pooling of data for our primary efficacy outcome showed a trend towards lower risk of rVTE with apixaban compared to rivaroxaban (RR 0.77, 95% CI 0.57–1.04, I² = 53%). Analysis of our primary safety outcome showed a significantly lower risk of major bleeding with apixaban compared to rivaroxaban (RR 0.68, 95% CI 0.61–0.76, I² = 0%). Apixaban was associated with significantly decreased risk of net clinical harm, clinically relevant non major bleeding (CRNMB) and any bleeding, compared to rivaroxaban (RR 0.75, 95% CI 0.61–0.92, I² = 50%; RR 0.58, 95% CI 0.50–0.67, I² = 7%; RR 0.64, 95% CI 0.59–0.70, I² = 0%, respectively).

Conclusions

Apixaban is associated with a significantly lower risk of major bleeding compared to rivaroxaban for treatment of VTE. Given the limitations of the existing evidence, further interventional studies comparing the two drugs are needed.

中文翻译：

---

利伐沙班与阿哌沙班治疗静脉血栓栓塞的疗效和安全性：观察性研究的系统评价和荟萃分析

背景

在治疗静脉血栓栓塞 (VTE) 时，包括利伐沙班和阿哌沙班在内的直接口服抗凝剂 (DOAC) 优于维生素 K 拮抗剂。我们进行了系统评价和荟萃分析，以比较利伐沙班与阿哌沙班治疗 VTE 的疗效和安全性。

方法

我们对直接比较成人 VTE 患者利伐沙班和阿哌沙班治疗的研究进行了电子检索。使用固定效应模型估计和汇总相对风险 (RR) 和 95% 置信区间 (CI)，除非存在显着异质性 (I ²  > 40%)，然后使用随机效应模型。主要疗效和安全性结局分别是复发性静脉血栓栓塞（rVTE）和大出血事件。

结果

我们的荟萃分析纳入了 9 项观察性研究，评估了 24,156 名患者的阿哌沙班治疗和 38,847 名患者的利伐沙班治疗。我们主要疗效结果的数据汇总显示，与利伐沙班相比，阿哌沙班有降低 rVTE 风险的趋势（RR 0.77，95% CI 0.57–1.04，I ²  = 53%）。我们的主要安全性结果分析显示，与利伐沙班相比，阿哌沙班的大出血风险显着降低（RR 0.68，95% CI 0.61–0.76，I ²  = 0%）。与利伐沙班相比，阿哌沙班与净临床伤害、临床相关非大出血 (CRNMB) 和任何出血的风险显着降低相关（RR 0.75，95% CI 0.61–0.92，I ²  = 50%；RR 0.58，95% CI 0.50–0.67，I ²  = 7%；RR 0.64，95% CI 0.59–0.70，I ²  = 0%）。

结论

与利伐沙班治疗 VTE 相比，阿哌沙班的大出血风险显着降低。鉴于现有证据的局限性，需要进一步的干预研究来比较这两种药物。