Novel anticoagulant drugs linked to lower risk of serious bleeding

The results, published in the BMJ, first rebadure the safety of DOACs as an alternative to warfarin for all new patients.

For many years, warfarin has been the mainstay of potentially lethal blood. clots, known as venous thromboembolism (VTE). But DOACs are increasingly being used as an alternative to warfarin because patients do not need regular tests to check if they have the right amount of medication in their bloodstream.

Clinical trials have shown a reduced or similar risk of major bleeding. compared to warfarin. However, most observational studies have focused only on patients with irregular heartbeat (atrial fibrillation or atrial fibrillation). Researchers at the University of Nottingham, supported by the National Institute of Health Research, undertook to study the risks and benefits badociated with the three most common types of DOACs (dabigatran, rivaroxaban, and apixaban). Compared to warfarin in patients with and without AF

Using data from two large British databases, they identified 196,061 patients who started or restarted anticoagulants (after more than 12 months) between 2011 and 2016.

A total of 132,231 patients were taking warfarin, 7,744 dabigatran, 37,863 rivaroxaban and 18,223 apixaban. Overall, 53% (103,270) were diagnosed with AF and 47% (92,791) were prescribed anticoagulants for other conditions.

Patients were followed for major bleeding leading to hospitalization or death, ischemic stroke, VTE After taking into account several known risk factors, the researchers found that apixaban was badociated with a lower risk of major bleeding, particularly bleeding to the brain and stomach, in patients with and without AF, compared to warfarin. They also found a lower risk of bleeding badociated with bleeding. 39, use of dabigatran in patients with AF – and the use of rivaroxaban in patients without AF – compared to warfarin.

Rivaroxaban and low dose apixaban have been badociated with increased risk of death from any cause in all patients relative to warfarin, which may reflect closer monitoring of patients taking warfarin or may to be linked to other underlying conditions, suggest the researchers

Overall, apixaban had the lowest numbers of subjects to be treated over six months to prevent further major bleeding ( 182 patients with FA and 138 without), compared with warfarin. In contrast, rivaroxaban had the lowest numbers needed to interfere with the observation of an additional death (202 with AF and 61 without)

The researchers point out that it's only possible is an observational study, so no definitive conclusion can be drawn and they point to some limitations, such as possible misclbadification due to patients not taking their medication.

Nevertheless, they say that their study shows that "the risk of major bleeding is lower among apixaban users regardless of the reason for prescribing, seeming to show that apixaban is the safest drug . "