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
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