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Mazou Ngou Temgoua: Why Does Apixaban Cause Less Bleeding than Rivaroxaban?
Mazou Ngou Temgoua/LinkedIn
Mar 23, 2026, 15:46

Mazou Ngou Temgoua: Why Does Apixaban Cause Less Bleeding than Rivaroxaban?

Mazou Ngou Temgoua, Contract hospital practitioner at Châteauroux-Le Blanc Hospital Center, shared on LinkedIn about a recent article by Lana A. Castellucci et al, adding:

“Why does apixaban cause less bleeding than rivaroxaban?

A recent trial in VTE shows a lower incidence of bleeding with apixaban compared to rivaroxaban.

But the real question lies elsewhere:

Where does this difference come from?

Several avenues:

1. Pharmacokinetics

  • Apixaban is given in 2 doses – more stable concentrations
  • Rivaroxaban in 1 dose – higher plasma peaks

2. Intensity of factor Xa inhibition

A more ‘smoothed’ inhibition could further preserve physiological hemostasis

3. Induction Diagram (highlighted in this article)

  • 7 days for apixaban
  • 21 days for rivaroxaban

Are we really comparing two molecules… or two anticoagulation strategies?

Key Message:

  • If the difference is related to the schema, it is potentially modifiable.

And this opens up a simple question:

Should we rethink the initial phase of rivaroxaban in VTE?

The answer is not yet known.

But the debate deserves to be asked.

And you, what is your reading?”

Title: Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism

Authors:  Lana A. Castellucci, Vivien M. Chen, Michael J. Kovacs, Alejandro Lazo-Langner, Peter Greenstreet, Susan Kahn, Benoit Côté, Sam Schulman, Kerstin de Wit, James Douketis, Deepa Suryanarayan, Tony Wan, Erik Yeo, Genevieve Le Templier, Huyen A. Tran, Abbey Willcox, Helen J. Crowther, Ritam Prasad, Sudeep Shivakumar, Etimbuk Umana, Fionnuala Ni Ainle, Tobias Tritschler, Stefano Barco, Jean-Philippe Galanaud, Marc Blondon, Lisa Baumann Kreuziger, Susan Solymoss, Clive Kearon, Erin Thomas, Tim Ramsay, Gregoire Le Gal, Marc Rodger

Read the Full Article on NEJM

Mazou Ngou Temgoua

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Abbey Willcox Alejandro Lazo-Langner Apixaban Benoit Côté Clive Kearon Deepa Suryanarayan Erik Yeo Erin Thomas Etimbuk Umana Fionnuala Ní Áinle Genevieve Le Templier Gregoire Le Gal Health Helen J. Crowther Hematology Hemostasis Hemostasis News Hemostasis Today Huyen A. Tran James Douketis Jean-Philippe Galanaud Kerstin de Wit Lana A. Castellucci Lisa Baumann Kreuziger Marc Blondon Marc Rodger Mazou Ngou Temgoua Medicine Michael J. Kovacs NEJM Peter Greenstreet Ritam Prasad Rivaroxaban Sam Schulman Stefano Barco Sudeep Shivakumar Susan Kahn Susan Solymoss Tim Ramsay Tobias Tritschler Tony Wan Vivien M. Chen VTE
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