People with the irregular heart rate condition atrial fibrillation often use blood thinners to help prevent a stroke.
In a new study, researchers found that one of those medications might stand out as safer and more effective.
They found that a-fib patients on the drug Eliquis (apixaban) had a slightly lower risk of blood clots and stroke than those on Xarelto (rivaroxaban)—a clot-preventing drug in the same class.
They were also much less likely to suffer gastrointestinal bleeding as a side effect of their medication.
The research was conducted by a team at the University of Toronto and elsewhere.
Atrial fibrillation affects 3 to 6 million Americans, according to the U.S. Centers for Disease Control and Prevention.
It arises when the heart’s upper chambers (the atria) beat erratically instead of maintaining a normal rhythm.
The problem is not immediately life-threatening, but it can allow blood to pool in the atria.
When that happens, a blood clot can form, and potentially be pumped from the heart and into a blood vessel supplying the brain—causing a stroke.
That’s why people with a-fib commonly take clot-preventing drugs (anticoagulants) like Eliquis and Xarelto.
They belong to a newer class of medications called direct oral anticoagulants, or DOACs.
Guidelines recommend that most a-fib patients take a DOAC rather than an older medication, warfarin because they are safer, more effective and easier to take.
But the guidelines do not say whether anyone DOAC is better than another.
In the study, the team analyzed health insurance claims from nearly 79,000 U.S. adults who started on Eliquis or Xarelto between 2012 and 2019.
On average, the team found Eliquis patients did better. Their risk of a stroke or other blood clot was 18% lower—at a rate of 6.6 per 1,000 patients per year, versus 8 per 1,000 among Xarelto patients.
When it came to safety, the advantage was bigger. Eliquis patients had a 42% lower risk of internal bleeding:
They suffered bleeding problems at a rate of about 13 per 1,000 each year, compared with 22 per 1,000 in the Xarelto group.
The difference was mainly seen in stomach bleeding.
The team says that the results are based on “incomplete data” from insurance records that leave many questions open.
For example, he said, Eliquis patients were a bit older, so their medication doses might have been lower—which would reduce the chances of bleeding.
Lakkireddy—who gets speaking fees from both of the drugmakers, Pfizer and Janssen—also pointed to the bigger picture: Since the medications’ debut, there has been “hair-splitting” over which is better, along with marketing battles.
But what’s clear is that the newer drugs are better than warfarin.
The lead author of the study is Dr. Michael Fralick of the University of Toronto and Mount Sinai Hospital in Toronto.
The study is published in the Annals of Internal Medicine.
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