Bleeding and Thromboembolism in Atrial Fibrillation: Apixaban vs Rivaroxaban

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Journal name: The Malaysian Journal of Medical Sciences
Original article title: Bleeding and Thromboembolic Events in Patients with Non-Valvular Atrial Fibrillation Treated with Apixaban or Rivaroxaban
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Ahmad Salihin ABDULLAH, Hwee Pheng TAN, Shamin MOHD SAFFIAN


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: Bleeding and Thromboembolic Events in Patients with Non-Valvular Atrial Fibrillation Treated with Apixaban or Rivaroxaban

Year: 2022 | Doi: 10.21315/mjms2022.29.2.15

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

Rivaroxaban and apixaban are oral anticoagulants often prescribed for stroke prevention in patients with atrial fibrillation. Despite their effectiveness, their use is associated with an elevated risk of bleeding events. This study aimed to analyze the incidence of thromboembolic and bleeding events among patients treated with these drugs at a tertiary hospital in Malaysia. Medical records from 114 patients were reviewed to understand the safety profile of rivaroxaban and apixaban, with a focus on identifying bleeding risk factors through statistical analyses.

Important Concept: Bleeding Risks and Predictors

The study found that out of the 144 patients analyzed, 12 experienced thromboembolic events, comprising 5 instances of ischaemic strokes and 7 cases of myocardial infarction. In terms of bleeding, 32 patients (22.20%) experienced some form of bleeding event, with 7 classified as major bleeding. Notably, the use of concomitant antiplatelet medications and levels of serum creatinine emerged as significant predictors of bleeding events. Specifically, the study indicated that the risk of bleeding increased by a factor of 4.17 when antiplatelet drugs were used and that elevated serum creatinine levels were correlated with a heightened bleeding risk during events, underscoring the importance of monitoring these factors in patients on anticoagulant therapy.

Conclusion

The findings of this retrospective study highlight that while the rates of thromboembolic events associated with rivaroxaban and apixaban are low (8.33%), the incidence of bleeding (around 22%) poses concerns that cannot be overlooked. These results emphasize the need for careful risk assessment and management strategies in patients receiving these anticoagulants, taking into account concomitant medications and renal function. The study contributes valuable data critical for understanding the safety and efficacy of oral anticoagulants within the Malaysian context, paving the way for future research in this area.

FAQ section (important questions/answers):

What is the focus of the study on rivaroxaban and apixaban?

The study examines bleeding and thromboembolic events associated with rivaroxaban and apixaban in patients treated for stroke prevention in atrial fibrillation.

What were the results regarding thromboembolic events from the study?

Out of the studied patients, only 12 patients (8.33%) experienced thromboembolic events, including 5 cases of ischemic stroke and 7 cases of myocardial infarction.

What factors increased the risk of bleeding events during the study?

The study identified that concomitant antiplatelet use and higher serum creatinine levels significantly increased the risk of bleeding events in patients taking rivaroxaban or apixaban.

What were the overall findings related to bleeding events?

Approximately 22% of patients experienced bleeding events, with 7 classified as major bleeding. The risk was particularly high for those on antiplatelet therapy and with elevated serum creatinine.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Bleeding and Thromboembolism in Atrial Fibrillation: Apixaban vs Rivaroxaban”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Bleeding:
Bleeding is a critical medical term that refers to the loss of blood from the circulatory system. It is particularly relevant in the context of anticoagulant medications like rivaroxaban and apixaban, which significantly increase the risk of bleeding events. Understanding bleeding can help in evaluating the safety and effectiveness of these drugs, leading to better patient management strategies.

2) Male:
Male refers to the gender of individuals, and it's significant in medical studies to assess gender-specific differences in treatment outcomes. In this study, male patients formed a substantial portion of the cohort, indicating that results might be influenced by gender-related factors in bleeding and thromboembolic risks associated with anticoagulant use.

3) Table:
The term table is used to present data in a structured format that allows for easy comparison and analysis. In the research initiative, several tables summarize patient demographics, thromboembolic and bleeding events, and other relevant information, facilitating a better understanding of the findings and aiding in effective communication among researchers.

4) Study (Studying):
A study is a systematic investigation aimed at discovering or interpreting facts regarding a particular subject. In this context, the study examines the bleeding and thromboembolic events associated with rivaroxaban and apixaban. The study's design enables the identification of significant trends and risk factors among the patient population being analyzed.

5) Disease:
Diseases refer to pathological conditions that disrupt normal bodily functions and are crucial to understanding different patient outcomes. The study specific interest in diseases like atrial fibrillation and thromboembolism highlights the importance of these conditions in determining treatment decisions, patient management, and overall therapeutic strategies when using anticoagulants.

6) Rules:
Rules refer to established guidelines or principles that govern practices in clinical environments. In the context of the study, rules may relate to the administration of anticoagulation therapies, monitoring for adverse effects, and clinical decision-making processes to minimize risks such as bleeding or thromboembolic events in patients receiving these medications.

7) Drug:
A drug is any substance used to diagnose, cure, treat, or prevent disease. In this research, rivaroxaban and apixaban qualify as drugs designed to reduce the risk of stroke and systemic embolism, making it vital to evaluate their safety profile, dosage regimens, and potential side effects such as bleeding among patients.

8) Aristotle:
Aristotle refers to a landmark clinical trial that compared the efficacy of apixaban against warfarin in patients with atrial fibrillation. The findings from the ARISTOTLE trial serve as a benchmark for evaluating newer anticoagulants and contribute to understanding their safety and effectiveness in real-world patient populations.

9) Ulcer:
Ulcer signifies a break in the skin or mucous membrane that fails to heal properly. In the context of the study, prior peptic ulcer disease presents as a significant risk factor for bleeding events. Recognizing the history of ulcers can aid healthcare providers in risk stratification when prescribing anticoagulants.

10) Blood:
Blood is the vital fluid that circulates in the cardiovascular system, delivering necessary substances to cells and removing waste products. In the context of anticoagulation therapy, understanding blood's role is crucial for assessing bleeding risks, managing hemoglobin levels, and evaluating overall patient health outcomes following treatment with anticoagulants.

11) Hand:
While 'hand' may not seem directly relevant in a medical context, it can symbolize assessment tools utilized in clinical evaluation. In this study, methods for monitoring and documenting patient outcomes, including clinical examinations, may involve hands-on evaluations, illustrating the importance of comprehensive clinical assessments in managing anticoagulation therapy.

12) Civalinkam:
Sivalingam is likely a reference to a researcher or academic who contributed to the study or provided relevant insights. Acknowledging the contributions of various authors and researchers emphasizes the collaborative nature of research, enhancing the credibility of the study findings and validating the associated methodologies used in the investigation.

13) Patel:
Similar to Sivalingam, Patel likely refers to one of the researchers or authors involved in the study. Recognizing individual contributors and their work highlights the diverse expertise and perspectives that enrich the study, providing validation to the research outcomes regarding the use and safety of anticoagulants in a clinical setting.

14) Accumulation (Accumulating, Accumulate):
Accumulation is the gradual gathering or increase of substances, which in a medical context often refers to medications in the body. In this study, understanding the accumulation of anticoagulants like rivaroxaban and apixaban is crucial for assessing risks, especially in patients with kidney impairment, leading to potential serious bleeding events and adverse outcomes.

15) Discussion:
Discussion refers to the section of a research paper where results are interpreted and contextually explored. It synthesizes findings and implications, allowing researchers to critically analyze their outcomes, compare with existing literature, address limitations, and suggest future research directions concerning thrombosis and bleeding risks associated with the use of anticoagulants.

16) Channel:
Channel in a medical context may refer to physiological pathways for drug absorption, metabolism, or elimination. Understanding the channels through which anticoagulant medications operate can provide insight into their pharmacokinetics, influencing treatment strategies and enhancing safety profiles concerning potential adverse effects such as bleeding or thrombosis.

17) Reason:
Reason refers to the rationale behind certain choices in medical treatment. In this context, understanding the reasons for selecting a specific anticoagulant therapy like rivaroxaban or apixaban, based on the patients' characteristics, helps tailor therapy to individual risk profiles, ultimately optimizing patient outcomes while minimizing adverse reactions.

18) Indian:
Indian likely signifies a demographic component of the study, acknowledging the ethnic diversity within the patient population. Understanding variations among ethnic groups is essential in pharmacology, as genetic differences may affect drug metabolism, efficacy, and safety profiles, leading to the need for culturally relevant research and customized treatment protocols.

19) Visit:
Visit refers to the interaction between patients and healthcare providers for clinical evaluation or follow-up. The frequency and nature of medical visits can significantly impact treatment outcomes, patient adherence to therapy, and monitoring for potential adverse events, especially during anticoagulation therapy when patients are at heightened risk for bleeding incidents.

20) Beta:
Beta could relate to beta-blockers, a class of medications frequently used in patients with heart conditions. In patients on anticoagulant therapy, understanding the interactions and cumulative effects of beta-blockers on cardiovascular management is crucial for formulating an effective treatment regimen while minimizing the risk of adverse events such as bleeding.

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