New anticoagulants seem to be a safe alternative to warfarin, a new observational study has revealed.
Direct oral anticoagulants (DOACs), which are prescribed to treat serious blood clots, are associated with reduced risks of major bleeding compared with warfarin, according to researchers at the University of Nottingham, which investigated the risks and benefits of dabigatran, rivaroxaban, and apixaban - the three most commonly used DOACs - compared with warfarin in patients with and without atrial fibrillation.
They used data from two large UK primary care databases, identifying 196,061 patients who started or restarted anticoagulants, after more than a 12-month gap, between 2011 and 2016.
Of these, 132,231 patients were taking warfarin, 7,744 dabigatran, 37,863 rivaroxaban, and 18,223 apixaban. A total of 53% (103,270) were diagnosed with atrial fibrillation, while the remaining 47% (92,791) were prescribed anticoagulants for other conditions.
Patients were monitored for major bleeds leading to hospital admission or death, ischaemic stroke, venous thromboembolism, and all-cause mortality.
Writing in The BMJ, the research team says it found apixaban was associated with a lower risk of major bleeding, particularly brain and gastric bleeds, in all patients, than the risk from warfarin.
They also found a lower risk of brain bleeds associated with use of dabigatran in patients with atrial fibrillation - and with use of rivaroxaban in patients without AF ñ than from warfarin.
However, rivaroxaban and low dose apixaban were associated with increased risks of deaths from any cause in all patients when compared with warfarin. The researchers say this may reflect closer monitoring of patients taking warfarin or may be related to other underlying conditions.
Although an observational study, the team say the study shows that “the risk of major bleeding is lower in apixaban users regardless of the reason for prescribing, appearing to show apixaban to be the safest drug.”
They add: “Our results give an initial, reassuring, indication of the risk patterns for all patients taking anticoagulants, in particular with respect to those prescribed apixaban.”
Source: Vinogradova Y, Coupland C, Hill T et al. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ 4 July 2018. doi:10.1136/bmj.k2505
Link: http://www.bmj.com/content/362/bmj.k2505
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