Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

McHugo, Jeanie

Keywords

Nonvalvular atrial fibrillation, Apixaban, Rivaroxaban, Chronic kidney disease, BMI Safety and Efficacy of Apixaban vs Rivaroxaban

Abstract

Nonvalvular atrial fibrillation, the most common cardiac arrhythmia in developed countries, warrants anticoagulation for stroke prevention. Updated guidelines recommend direct oral anticoagulants (DOACs) over historically used warfarin. The purpose of this review is to compare clinical safety and efficacy outcomes between apixaban and rivaroxaban. In patients with nonvalvular atrial fibrillation on a direct oral anticoagulant, is there a significant difference in safety and efficacy between apixaban and rivaroxaban? Does decreased kidney function change safety and efficacy? Does varying BMI such as low weight or obesity change safety and efficacy? A retrospective literature review was conducted utilizing PubMed databases. Articles included in this review were published in the past five years and compared anticoagulants in the treatment of nonvalvular atrial fibrillation. There were mixed results in the articles analyzed in comparing safety and efficacy in patients without kidney disease and of normal BMI. One showed a decreased risk of stroke and four supported significantly lower bleeding risk while taking apixaban compared to rivaroxaban. When comparing the two medications in patients with chronic kidney disease, there was support to show apixaban was safer and more effective in patients that were in stages 3 and 4. With an elevated BMI being in the inclusion criteria there was no significant difference found in safety and efficacy between the two medications, but there was support to show that they were both better than warfarin based on this criteria. There are no head-to-head direct prospective studies, therefore, one cannot truly say one medication is safer or more effective than the other. There can only be inferences made using these retrospective studies, although they do not all show the same evidence or provide overwhelming support for one drug or the other.

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