{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:13:38Z","timestamp":1789726418258,"version":"4.0.1"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Real\u2010world research has identified differences in effectiveness and safety between direct oral anticoagulants (DOACs) when used to reduce risks of stroke and systemic embolism in patients with atrial fibrillation. However, treatment decisions and subsequent outcomes are poorly understood in patients with atrial fibrillation who experience bleeding when receiving a DOAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">A retrospective observational study was conducted using US claims data from Optum\u2019s Clinformatics Data Mart Database (January 2012 through March 2024). The study population comprised adults with nonvalvular atrial fibrillation who initiated a DOAC and had a subsequent claim for bleeding. After propensity score matching, patients who persisted with the same DOAC after bleeding were compared with those who switched to another DOAC. The main outcomes were major bleeding and stroke\/systemic embolism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 59\u2009620 apixaban initiators and 21\u2009004 rivaroxaban initiators with bleeding while on therapy, 408 apixaban\u2010to\u2010rivaroxaban switchers were matched with 2040 persistent apixaban users, and 901 rivaroxaban\u2010to\u2010apixaban switchers were matched with 4505 persistent rivaroxaban users. Compared with persisting with apixaban following a bleeding event, apixaban\u2010to\u2010rivaroxaban switching was associated with a higher risk of major bleeding (hazard ratio [HR], 1.690 [95% CI, 1.130\u20132.527]) and a similar risk of stroke\/systemic embolism (HR, 1.793 [95% CI, 0.765\u20134.202]). Compared with persisting with rivaroxaban, rivaroxaban\u2010to\u2010apixaban switching was associated with a lower risk of major bleeding (HR, 0.651 [95% CI, 0.460\u20130.920]) and a similar risk of stroke\/systemic embolism (HR, 0.783 [95% CI, 0.371\u20131.652]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">These findings suggest that the choice of DOAC after a bleeding event can affect treatment outcomes in patients with atrial fibrillation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044113","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:02:32Z","timestamp":1768827752000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Impact of Switching From or Persisting With Rivaroxaban or Apixaban After a Bleeding Event: A Real\u2010World Study in Patients With Nonvalvular Atrial Fibrillation"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. 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