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02 November 2017

New drugs could offer a safe alternative to warfarin for the treatment of venous thromboembolism, researchers have reported.

Warfarin "has inherent limitations that detract from its therapeutic utility", say the researchers in the BMJ.

"In contrast, direct oral anticoagulants have relatively stable pharmacokinetics that remove the need for regular monitoring and dose adjustment."

Although previous trials have supported the efficacy and safety of direct oral anticoagulants compared with warfarin, they are not usually designed to detect differences in safety outcomes.

Researchers, led by Dr Brenda Hemmelgarn, of the University of Calgary, Canada, carried out a retrospective study looking back over figures from 2009 to 2016 from Canada and the United States. It included information on 59,525 adults newly diagnosed with venous thromboembolism and prescribed either direct oral anticoagulants or warfarin within 30 days. Just over 3% of the participants had a major bleed and just under 2% died over an average follow-up of 85 days.

"The risk of major bleeding was similar for direct oral anticoagulants compared with warfarin use," report the authors.

They add that "the overall direction of the association favoured direct oral anticoagulants use". No difference was found in the risk of death, and outcomes were similar across groups, such as patients with and without chronic kidney disease, age groups, or between male and female patients.

However they point out that, as an observational study, no firm conclusions can be drawn about cause and effect. Further studies are needed to understand the safety of direct oral anticoagulants over the longer term and among patients with advanced chronic kidney disease, they conclude.

Source: Jun, M. et al. Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study. BMJ 18 October 2017; doi: 10.1136/bmj.j4323

Link: http://www.bmj.com/content/359/bmj.j4323

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