Bleeding Risk Comparison Between Apixaban and Rivaroxaban in Patients with Venous Thromboembolism
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on April 8th, 2026
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Venous thromboembolism is a common cardiovascular condition that can have detrimental complications. Medications such as apixaban and rivaroxaban can be used to treat the condition and prevent recurrence. Both agents work by binding to the clotting factor Xa; this would prevent it from catalyzing the creation of thrombin needed for blood clotting. Because of this anticoagulant effect, a study, recently published in the New England Journal of Medicine, was conducted to compare the risk of bleeding between apixaban and rivaroxaban.
Funding Source(s): Canadian Institutes of Health Research
The clinical study was performed in Canada, Australia, and Ireland, and it included 2760 participants with an average age of 58 years old who had been affected with some forms of embolism disease. Around 50% of them were diagnosed with only deep-vein thrombosis, with the other half being affected with pulmonary embolism. Antiplatelet medications were also used by some of the participants, and the percentage of usage is selected to be equal between treatment groups at around 2.7%.
The participants were randomly assigned to be treated with either apixaban or rivaroxaban for 3 months. Rivaroxaban was given at an initial dose of 15 mg twice daily after 21 days, which is then reduced to 20 mg once a day. Following a similar dose-reduction schedule, apixaban was started with 10 mg twice daily for 7 days followed by 5 mg twice a day. By the end of the 3-month treatment period, the researchers found that 3.3% of those treated with apixaban reported bleeding, significantly less than the 7.1% frequency in the rivaroxaban. This 56% reduction in bleeding is more prominent when looking specifically at major bleeding, which risk is further reduced by 84%. Both treatments have similar effectiveness, as both groups have around 1% risk of developing venous thromboembolism.
Funding Source(s): Canadian Institutes of Health Research
The clinical study was performed in Canada, Australia, and Ireland, and it included 2760 participants with an average age of 58 years old who had been affected with some forms of embolism disease. Around 50% of them were diagnosed with only deep-vein thrombosis, with the other half being affected with pulmonary embolism. Antiplatelet medications were also used by some of the participants, and the percentage of usage is selected to be equal between treatment groups at around 2.7%.
The participants were randomly assigned to be treated with either apixaban or rivaroxaban for 3 months. Rivaroxaban was given at an initial dose of 15 mg twice daily after 21 days, which is then reduced to 20 mg once a day. Following a similar dose-reduction schedule, apixaban was started with 10 mg twice daily for 7 days followed by 5 mg twice a day. By the end of the 3-month treatment period, the researchers found that 3.3% of those treated with apixaban reported bleeding, significantly less than the 7.1% frequency in the rivaroxaban. This 56% reduction in bleeding is more prominent when looking specifically at major bleeding, which risk is further reduced by 84%. Both treatments have similar effectiveness, as both groups have around 1% risk of developing venous thromboembolism.