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Apixaban (Eliquis) may provide better protection from stroke and bleeding events than rivaroxaban(Xarelto) for people living with atrial fibrillation (AF) and valvular heart disease (VHD). Israel Sebastian/Getty Images
  • New research finds that the prescription medication Apixaban (Eliquis) may provide better protection from stroke and bleeding events than rivaroxaban (Xarelto) for people living with atrial fibrillation (AF) and valvular heart disease (VHD).
  • About 60% of people with AF also have VHD, which increases the risk of stroke.
  • Anticoagulants reduce the risk of stroke by two-thirds.

In a recent study, researchers looked at four blood thinners used to prevent blood clots when treating atrial fibrillation to determine the best for minimizing bleeding risks.

The study’s results, published in the Annals of Internal Medicine, indicated that apixaban (Eliquis) had the lowest risk of gastrointestinal bleeding. The four blood thinners the researchers examined are:

The scientists looked at data from more than 500,000 patients who used direct oral anticoagulants in the UK, France, Germany, and the US. They found that all four of the drugs reduced the risk of ischemic stroke, brain bleeds, and all-cause mortality, but apixaban was better at lowering the incidence of gastrointestinal bleeding.

In a different study published in October 2022 in the journal Annals of Internal Medicine, scientists compared apixaban to rivaroxaban. In this study, the researchers found that apixaban could provide better protection from ischemic stroke or systemic embolism and bleeding than rivaroxaban (Xarelto).

Other research compared apixaban to warfarin, but up until now, there have not been trials comparing apixaban to rivaroxaban.

Apixaban and rivaroxaban are anticoagulants, or blood thinners, that work to prevent blood clots in people with atrial fibrillation as well as other related conditions.

The researchers for this study examined data from Optum’s deidentified Clinformatics Data Mart Database to identify 19,894 patients, 9,947 took apixaban, and 9,947 took rivaroxaban. Data on each person included enrollment in a healthcare plan, demographics, characteristics, outpatient, inpatient, and prescription claims, and laboratory test data.

All patients were over 18 years and filled first-time prescriptions for the medicines. All had diagnoses of atrial fibrillation (AF) and valvular heart disease (VHD).

After analyzing the information, the researchers determined that apixaban was associated with a 43% lower risk of a clotting event and a 49% lower risk of a gastrointestinal or intracranial bleeding event compared to rivaroxaban.

According to the study, about 60% of people with AF also have VHD, which increases the risk of stroke. Anticoagulants reduce the risk of stroke by two-thirds.

“Only one uncommon type of valve disease in the US — called mitral stenosis — warrants blood thinners, but almost all forms of AF generally need some protection from blood clots forming in the heart for which we use blood thinners as a first line strategy, says Shephal Doshi, MD, cardiac electrophysiologist and director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, CA.

“Atrial fibrillation is an irregular, and often fast, heart rhythm. In a normal heart, the upper chambers (or atria) will contract synchronously and send blood to the bottom chambers of the heart (the ventricles),” Nadia Jafar, MD, a cardiologist with Torrance Memorial Medical Center, Cedars Sinai explained to Healthline. “In atrial fibrillation, instead of the atria contracting synchronously, they start beating erratically and out of sync with the bottom chambers. This can lead to increased heart rates and symptoms.”

Some people with AF have no symptoms. For those that do, Jafar said they include:

  • Palpitations
  • Shortness of breath
  • Chest pain
  • Dizziness
  • Fatigue

“Atrial fibrillation is most commonly a disease of aging,” says Doshi. “But some people do develop AF at a young age. When this happens, it is most likely genetic. Some environmental factors can cause AF, such as high levels of stimulant or alcohol abuse.”

Valvular heart disease is a general term used when any valve in the heart is damaged or diseased, according to the CDC. The heart has four valves – mitral, tricuspid, aortic, and pulmonary, which open and close to regulate blood flow to, from, and within the heart. The aortic valve is the one most likely to be diseased. When valves are diseased, the heart can’t effectively pump blood and must work harder to function correctly. This can cause heart failure or cardiac arrest.

According to the American Heart Association, symptoms of valve disease include:

  • Chest pain
  • Palpitations
  • Shortness of breath
  • Difficulty catching your breath
  • Fatigue
  • Weakness
  • Lightheadedness
  • Fainting
  • Swollen ankles, feet, or abdomen
  • Inability to maintain a regular activity level

“The most common cause of VHD is aging. Uncontrolled blood pressure over many years can cause the heart to change shape and the valves to leak,” says Doshi. “Since AF and VHD commonly develop in older adults, we often see them together. The VHD that puts stress on the atrium and causes it to dilate can trigger AF.”

Your heart works 24 hours a day to keep you alive. It is the most crucial organ in the body. When you ignore heart health, you risk cardiovascular disease, which can lead to heart attack and stroke.

Harvard Health offers tips on keeping your heart healthy:

  • Get regular exercise. If you don’t exercise, start with a 10-minute walk.
  • Eat a heart-healthy diet, including fruits, vegetables, nuts, fish, and whole grains.
  • Cut out sugary drinks.
  • Practice deep breathing several times each day to help reduce stress and blood pressure.
  • Wash your hands often to help prevent the flu, pneumonia, and other infections that are hard on your heart.