Bleeding and Thromboembolic Events in Patients with Non-Valvular Atrial Fibrillation Treated with Apixaban or Rivaroxaban

Rivaroxaban and apixaban are effective oral anticoagulants, but their usage has been associated with an increased risk of bleeding events. This study examined the bleeding and thromboembolic events of rivaroxaban and apixaban. Medical records from 114 patients (rivaroxaban n = 64, apixaban n = 80) treated for stroke prevention in atrial fibrillation at a tertiary hospital in Malaysia were retrospectively reviewed. Patients with bleeding or stroke/ systemic embolism events were identified and the bleeding risk factors were investigated using logistic regression analysis. Stroke or systemic embolism after treatment with Factor Xa (FXa) inhibitor occurred in 12 (8.33%) of the patients, 5 (3.47%) were ischaemic stroke and 7 (4.86%) of them were presented with myocardial infarction. Bleeding occurred in 32 (22.20%) patients, where 7 (4.90%) were presented with major bleeding (rivaroxaban n = 3, apixaban n = 4), while another 25 (17.40%) experienced clinically relevant non-major bleeding. Furthermore, concomitant antiplatelet used and serum creatinine level were significant predictors of bleeding events (P < 0.05). In conclusion, stroke or systemic embolism events were low for both drugs, but this may be an underestimate of the true prevalence due to the small sample size in the present study.