Ray WA, Chung CP, Stein CM, et al. - In a population of Medicare beneficiaries 65 years or older with atrial fibrillation, a significantly elevated risk of major ischemic or hemorrhagic events was observed in those treated with rivaroxaban vs those who received apixaban.

• This is a retrospective cohort study comprising 581,451 patients 65 years or older enrolled in Medicare with atrial fibrillation and treated with rivaroxaban or apixaban, to compare major ischemic and hemorrhagic outcomes between rivaroxaban and apixaban treated groups.

• For major ischemic or hemorrhagic events, the adjusted incidence was 16.1 per 1000 person-years with rivaroxaban vs 13.4 per 1000 person-years with apixaban, a difference that was statistically significant.

• Elevated risk for both major ischemic events and hemorrhagic events, including fatal extracranial bleeding, was found in the rivaroxaban group.

• Treatment with rivaroxaban was associated with increased risk of nonfatal extracranial bleeding, fatal ischemic/hemorrhagic events, and total mortality.