Rivaroxaban vs Apixaban and Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation —Reply

In Reply Dr Gu questions whether the differences in outcomes reported in our study of rivaroxaban vs apixaban are clinically significant. A widely accepted measure of clinical impact is the number needed to harm, estimated as the reciprocal of the rate difference. We found 1 additional major ischemic or hemorrhagic event for every 370 patients treated with rivaroxaban compared with apixaban. Given the severity of the study events —stroke, other intracranial hemorrhage, and fatal bleeding—we disagree with the contention that the difference is not clinically important. Furthermore, the number needed to harm for nonfatal extracranial bleeding, a serious event involving hospitalization, was 47.3. We believe differences of th is magnitude provide a compelling clinical rationale for apixaban as the preferred drug for stroke prevention in atrial fibrillation.
Source: JAMA - Category: General Medicine Source Type: research