Comparison of Anticoagulants

Apixaban and rivaroxaban are the most commonly used oral

anticoagulants for the treatment of acute venous thrombo-

embolism. An international study with a prospective, rand-

omized, open-label, and blinded endpoint design investigated

the extent to which the risk of bleeding differs between the

two anticoagulants. For this purpose, 2,760 patients with

acute symptomatic pulmonary embolism or proximal deep

vein thrombosis were randomized in a 1:1 ratio to receive

either apixaban (n = 1,370) or rivaroxaban (n = 1,390) for

three months. Apixaban was administered at a dose of 10 mg

twice daily for seven days, followed by 5 mg twice daily,

while rivaroxaban was administered at a dose of 15 mg

twice daily for 21 days, followed by 20 mg daily. The primary

endpoint was clinically relevant bleeding, defined as a com-

bination of major bleeding or clinically relevant non-major

bleeding. Secondary endpoints included all-cause mortality.

After three months, events related to the primary endpoint

occurred in 44 of 1,345 patients (3.3%) in the apixaban

group and in 96 of 1,355 patients (7.1%) in the rivaroxaban

group (relative risk [RR]: 0.46; 95% confidence interval [CI]:

0.33 to 0.65; p < 0.001). All-cause mortality occurred in one patient (0.1%) in the apixaban group and in four patients (0.3%) in the ri¬varoxaban group (RR: 0.25; 95% CI: 0.03 to 2.26). Serious adverse events not related to bleeding or ve- nous thrombosis were reported in 36 patients (2.7%) in the apixaban group and in 30 patients (2.2%) in the rivaroxaban group. According to the authors, the results show that the risk of clinically relevant bleeding during a three-month treatment period in patients with acute venous thrombo- embolism was significantly lower with apixaban than with rivaroxaban.  vh Quelle: Castellucci LA et al.: Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. N Engl J Med. 2026;394(11):1051-1060. doi:10.1056/NEJMoa2510703 JOURNAL CLUB swiss cardiology 1 | 2026 27