MONDAY, July 8, 2024 (HealthDay News) — For patients with cirrhosis and nonvalvular atrial fibrillation (AF), initiators of rivaroxaban or warfarin versus apixaban have significantly higher rates of major hemorrhage, according to a study published online July 9 in the Annals of Internal Medicine.

Tracey G. Simon, M.D., M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues compared the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in a population-based propensity score-matched cohort study involving patients with cirrhosis and AF.

The researchers found that compared with apixaban initiators, rivaroxaban initiators had significantly higher rates of major hemorrhagic events (rate difference, 33.1 per 1,000 person-years; hazard ratio, 1.47); no significant differences were seen in the rates of ischemic events or death. Across subgroup and sensitivity analyses, the rates of major hemorrhage were consistently higher. Compared with apixaban initiators, warfarin initiators also had significantly higher rates of major hemorrhage (rate difference, 26.1 per 1,000 person-years; hazard ratio, 1.38), especially hemorrhagic stroke (rate difference, 9.7 per 1,000 person years; hazard ratio, 2.85).

“These findings suggest apixaban may offer safety benefits over both rivaroxaban and warfarin in patients with cirrhosis and AF engaged in routine clinical care,” the authors write.

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