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Friday, February 14, 2014

New Oral Anticoagulants More Effective and Safer Than Warfarin in AFib: Meta-analysis Results

Information sourced from NEJM Journal Watch:

For Atrial Fibrillation, New Oral Anticoagulants Are More Effective and Safer than Warfarin

Meta-analysis results were consistent across a wide range of patients.

Three new oral anticoagulants — the thrombin inhibitor dabigatran (Pradaxa) and the factor Xa inhibitors apixaban (Eliquis) and rivaroxaban (Xarelto) — are approved for preventing stroke and systemic embolism in patients with atrial fibrillation. Edoxaban, a factor Xa inhibitor that is not yet approved by the FDA, is noninferior to warfarin for these indications (NEJM JW Gen Med Nov 19 2013) [PubMed® abstract]. Now, researchers report a meta-analysis of the four major clinical trials in which these newer anticoagulants were compared head to head with warfarin in 72,000 patients (mean age, 72) with atrial fibrillation. Median follow-up was 2 to 4 years.

Compared with warfarin, the newer agents were associated with significantly fewer strokes and systemic embolism events (19% fewer, driven mainly by 51% fewer hemorrhagic strokes). The new anticoagulants and warfarin were similarly effective in preventing ischemic stroke and myocardial infarction. Among those who received the newer agents, intracranial hemorrhage was 52% less common, and all-cause mortality was 10% lower, but gastrointestinal bleeding was 25% more common. The new anticoagulants' effects relative to warfarin were consistent across all major subgroups, including those at different levels of stroke risk (as measured by CHADS2 score).

COMMENT

The new oral anticoagulants seem to offer clear advantages over warfarin in efficacy, safety, and convenience in patients who have atrial fibrillation, although some adverse effects might emerge with longer-term use.

Bruce Soloway, MD reviewing Ruff CT et al. Lancet 2013 Dec 4.

CITATION(S):

Ruff CT et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. Lancet 2013 Dec 4; [e-pub ahead of print]. [PubMed® abstract]

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