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Clinical Articles, News & Views

Lower bleeding risk with apixaban versus VKAs

Apixaban is associated with a lower risk of bleeding than vitamin K antagonists (VKAs), which provides some reassurance regarding its safety, according to the authors of a meta-analysis published recently in the American Journal of Cardiology.1

The authors conducted a meta-analysis of randomised controlled trials (RCTs) in the MEDLINE, Embase, and Cochrane Library of Clinical Trials databases, comparing the risks of bleeding and all-cause mortality of apixaban (2.5 or 5 mg twice daily) to those of VKA. They included RCTs conducted in adults and published in English or French. Data were pooled across RCTs using random-effects meta-analytical models.

The systematic search identified five RCTs meeting inclusion criteria (n=24,435). These included patients with atrial fibrillation (n=18,358), total knee replacement surgery (n=458), and venous thromboembolism (n=5,619). Data pooled across RCTs revealed that apixaban was associated with reduced risks of any bleeding (RR 0.73, 95% CI 0.59 to 0.90) and a composite of major or clinically relevant non-major bleeding (RR 0.60, 95% CI 0.40 to 0.88).

Apixaban was also associated with a lower risk of intracranial bleeding (RR 0.42, 95% CI 0.31 to 0.58), while analyses of major and minor bleeding were inconclusive. Moreover, apixaban was associated with decreased all-cause mortality (RR 0.89, 95% CI 0.81 to 0.99), though this finding was driven by the results of ARISTOTLE.


1. Touma L, Filion KB, Atallah R, Eberg M, Eisenberg MJ. A meta-analysis of randomized controlled trials of the risk of bleeding with apixaban versus vitamin K antagonists. Am J Cardiol 2014.

Published on: December 19, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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