Two anticoagulants have similar effectiveness for stroke prevention - but apixaban has the edge when bleeding risk is a concern

The research findings by Anjolaoluwa Folorunsho, a University of Chester undergraduate, could help clinicians to make decisions that will benefit patients, especially when bleeding risk is a particular concern.

His meta-analysis. conducted during the final year of his bachelor's degree, will be highlighted at the Minoritised Life Scientists Future Forum (MLSFF26) at Edinburgh International Conference Centre from March 23 to 25. MLSFF26 is the only major conference in Europe dedicated to supporting and showcasing the contributions of marginalised and underrepresented communities in the life sciences. 

The science conference is expected to attract hundreds of scientists to Edinburgh. With the city’s remarkable history of scientific invention and discovery, it’s the ideal location for young scientists to share their own breakthroughs.

Atrial fibrillation

“Atrial fibrillation is a common arrhythmia that increases the risk of stroke significantly. Warfarin used to be the most utilized anticoagulant - however, it had a lot of issues. Such issues were its interactions with other drugs and foods, need for constant monitoring and a higher bleeding risk,” Anjolaoluwa explained. 

“Direct oral anticoagulants were introduced to address these issues but there are no direct comparative trials for them to assist clinicians in making decisions.

“In order to try and address this question, I decided to conduct a meta-analysis using published clinical trials to evaluate the safety (major bleeding risk) and efficacy (stroke prevention). I also included observational cohort studies (real-world studies) and additional RCTs to conduct a sensitivity analysis to ensure results were consistent with a controlled setting. The Bucher method is a statistical technique that allows one to indirectly compare two interventions, given there is a common comparator used for analysis.

“The results showed that apixaban and rivaroxaban are similar in stroke prevention while apixaban showed a 32% reduction in major bleeding compared to rivaroxaban.”

Safety profile

One possibility may be that the differing safety profile could be due to the twice-daily dosing for apixaban that allows more stable plasma levels, whereas rivaroxaban’s once-daily dosing regimen results in higher plasma concentrations, leading to more bleeding risk, Anjolaoluwa theorised.

“These findings help clinicians to be able to make decisions that can benefit patients. For example, where bleeding risk is a concern such as elderly patients or those with renal impairment, apixaban might be preferred,” he said.

“In future, direct comparative trials can assist in making clinical decisions more conclusive as people of different ages, stroke risk and renal function would be included. 

“Indirect comparisons provide a picture but have certain limitations - I had to assume the trials were the same in a lot of characteristics, also the slight differences in populations and study designs may introduce some confounding bias.”

Find out more about MLS Future Forum HERE.