Heavy menstrual bleeding on Rivaroxaban ‐ Comparison with Apixaban

Myers, Bethan; Webster, Amy

doi:10.1111/bjh.14003

Cited by 44 publications

(40 citation statements)

References 4 publications

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“…To achieve equivalence to warfarin (Einstein Investigators, 2010, Agnelli et al, 2013 the peak anticoagulant effect of rivaroxaban could be higher than apixaban to accommodate the once daily dosing (Salem et al, 2015). Other evidence that bleeding risk may be greater with rivaroxaban than apixaban comes from two network meta-analysis of phase III RCTs, which provided indirect evidence of higher major bleeding risk for rivaroxaban versus apixaban, though precision was poor (Mantha & Ansell, 2015;Sterne et al, 2017), an observational study that did not restrict to the 6-month primary treatment period (Dawwas et al, 2019), comparisons conducted in the context of atrial fibrillation (Norby & Alonso, 2017), and the observation of increased menstrual bleeding with rivaroxaban versus apixaban (Myers & Webster, 2016).…”

Section: Comparison Of Apixaban Versus Rivaroxabanmentioning

confidence: 99%

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

et al. 2019

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Summary Understanding of the comparative bleeding risks of oral anticoagulant (OAC) therapies for the primary treatment of venous thromboembolism (VTE) is limited. Therefore, among anticoagulant‐naïve VTE patients, we conducted comparisons of apixaban, rivaroxaban and warfarin on the rate of hospitalised bleeding within 180 days of OAC initation. MarketScan databases for the time‐period from 2011 to 2016 were used and, for each OAC comparison, new users were matched with up to five initiators of a different OAC. The final analysis included 83 985 VTE patients, who experienced 1944 hospitalised bleeding events. In multivariable‐adjusted Cox regression models, rate of hospitalised bleeding was lower among new users of apixaban when compared to new users of rivaroxaban [hazard ratio (95% confidence interval) 0·58 (0·41–0·80)] or warfarin [0·68 (0·50–0·92)]. Overall, the hospitalised bleeding rate was similar when comparing new users of rivaroxaban to new users of warfarin [0·98 (0·68–1·11)], though there was some suggestion that rivaroxaban was associated with lower bleeding risk among younger individuals. Findings from this large real‐world population concur with results from the randomised trial which found lower bleeding risk with apixaban versus warfarin and, for the first time, reveal a lower risk of bleeding in a comparison of apixaban versus rivaroxaban.

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Section: Comparison Of Apixaban Versus Rivaroxabanmentioning

confidence: 99%

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

et al. 2019

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“…104 It is unclear whether this problem occurs with the other DOACs. 105 Young women should be warned about this potential complication, and if it occurs, switching to the lower dose of the DOAC for the first few days of the menstrual cycle is usually sufficient for its control.…”

Section: Menstrual Bleedingmentioning

confidence: 99%

Evolving Treatments for Arterial and Venous Thrombosis

Chan

Eikelboom

Weitz

2016

Circulation Research

102

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“…Although ICH is less frequent in patients on DOACs, there is evidence that these drugs may increase gastrointestinal bleeding and be associated with heavy menstrual bleeding (Ruff et al , ; Myers & Webster, ). Reversal of the anticoagulant effect is an essential part of the management of major bleeding events (MBE) related to any anticoagulant in addition to providing the circulatory support with blood products until the anticoagulant effect wears off.…”

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confidence: 99%

Efficacy and safety of prothrombin complex concentrate in patients treated with rivaroxaban or apixaban compared to warfarin presenting with major bleeding

et al. 2018

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Summary This retrospective study investigated the efficacy and safety of prothrombin complex concentrates (PCCs) for management of major bleeding events (MBE) in 344 patients receiving the anticoagulants rivaroxaban, apixaban or warfarin during the period January 2016 to April 2018. Median (range) PCC dose was 2000 units (1000–4500). Intracranial haemorrhage (ICH) was the most common indication (137/344, 39·8%) for PCC use followed by gastrointestinal bleeding (93/344, 27%). ICH patients more frequently received rivaroxaban (62·5%) or apixaban (52·5%) compared to warfarin (34·5%), P = 0·002; and visceral bleeding patients received warfarin more frequently (24·2%) than rivaroxaban (5%) or apixaban (10%), P = 0·003. Median rivaroxaban and apixaban levels were 230 ng/ml (47–759) and 159 ng/ml (45–255). Median International Normalised Ratio pre‐ and post‐PCC in patients on warfarin were 3·4 (1·9–15·4) and 1·2 (1·0–1·9). Blood products use was the same between groups. Thirty‐day mortality and re‐bleeding rates in patients with ICH were 35% (P = 0·50) and 18% (P = 0·90) with no differences between the groups. Thrombosis occurred in 4·1% patients within 30 days with no difference between groups. Two of 91 (2·2%) patients with ICH only (both on warfarin) had ischaemic strokes within 30 days post‐PCC. In conclusion, there was no difference in the safety (thrombosis) or efficacy (30‐day mortality, re‐bleeding) in use of PCC for MBE in patients on warfarin, rivaroxaban or apixaban.

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Heavy menstrual bleeding on Rivaroxaban ‐ Comparison with Apixaban

Cited by 44 publications

References 4 publications

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

Evolving Treatments for Arterial and Venous Thrombosis

Efficacy and safety of prothrombin complex concentrate in patients treated with rivaroxaban or apixaban compared to warfarin presenting with major bleeding

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