It did occur early in treatment, and that was something I wish I had emphasized in the post. Someone else pointed out that switching someone from rivaroxaban to apixaban would not necessarily be safer, because so much of the bleeding risk is taken up front during the loading period (for both agents).
Pasting an astute user comment I received by email here:
"Quick comment that I think is relevant to this discussion. Rivaroxaban is daily, so for some patients it may have significant benefit in compliance compared to apixaban. Also, another analysis of COBRA said that most of bleeding was during the 3 weeks of loading at the 50mg dose. I haven’t dove into cobra myself yet, so don’t have insight on this. But it’s possible the bleeding risk is less once at the stable steady state 20mg daily dose. Which might argue against switching patients from rivaroxaban to apoxaban if they are already doing well. For new starts on anticoagulation it seems that apicaban is safest (presuming patients compliance will be the same regardless of aid whether on a daily basis or BID drug)."
Did the increased bleeding risk of rivaroxaban occur early in treatment?( Since it has longer loading dose duration)
It did occur early in treatment, and that was something I wish I had emphasized in the post. Someone else pointed out that switching someone from rivaroxaban to apixaban would not necessarily be safer, because so much of the bleeding risk is taken up front during the loading period (for both agents).
"In other words, after 16 years of the NOAC wars, apixaban wins."
- nice.
Pasting an astute user comment I received by email here:
"Quick comment that I think is relevant to this discussion. Rivaroxaban is daily, so for some patients it may have significant benefit in compliance compared to apixaban. Also, another analysis of COBRA said that most of bleeding was during the 3 weeks of loading at the 50mg dose. I haven’t dove into cobra myself yet, so don’t have insight on this. But it’s possible the bleeding risk is less once at the stable steady state 20mg daily dose. Which might argue against switching patients from rivaroxaban to apoxaban if they are already doing well. For new starts on anticoagulation it seems that apicaban is safest (presuming patients compliance will be the same regardless of aid whether on a daily basis or BID drug)."