Plain language summary of the direct oral anticoagulant switch study: effect of switching or continuing apixaban or rivaroxaban among people with non-valvular atrial fibrillation

Plain Language Summary: What is this summary about? This retrospective real-world study aimed to determine the risk of stroke/systemic embolism and major bleeding among people with non-valvular atrial fibrillation who started treatment with a direct oral anticoagulant and then either remained on their initial treatment or switched to another direct oral anticoagulant. The study focused on apixaban and rivaroxaban because they are the most commonly used direct oral anticoagulants. Non-valvular atrial fibrillation is a type of heart disorder that increases a person’s risk of stroke. Direct oral anticoagulants, like apixaban and rivaroxaban, are used to reduce the risk of stroke in people with non-valvular atrial fibrillation by preventing the formation of blood clots (i.e. when blood turns from liquid into a gel). As multiple treatments exist, people may switch between different treatments for various medical and non-medical reasons, such as treatments not working, side effects, or inability to access a specific treatment. Despite direct oral anticoagulant switching happening in medical treatment, there are limited data on the impact switching has on clinical outcomes (e.g. changes in a patient’s health, function, or quality of life). Therefore, this study was conducted to fill this real-world evidence gap. What are the key takeaways? The study found that switching from apixaban to rivaroxaban was associated with higher risks of stroke/systemic embolism and major bleeding versus remaining on apixaban. Switching from rivaroxaban to apixaban had a similar risk of stroke/systemic embolism but a lower risk of major bleeding compared to remaining on rivaroxaban. What were the main conclusions reported by the researchers? The study results suggest that direct oral anticoagulant choice when switching treatments could substantially affect the risks of stroke/systemic embolism and major bleeding in people with non-valvular atrial fibrillation, which may aid healthcare professionals and people in making informed decisions about their treatment.