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Direct oral anticoagulants safe, effective in real-world populations
In a meta-analysis of real-world nonrandomized studies, direct oral anticoagulants were as safe and effective as vitamin K antagonists — and often more so — in patients with nonvalvular atrial fibrillation.
The researchers analyzed 49 studies of rivaroxaban (Xarelto, Janssen/Bayer) vs. vitamin K antagonists, 79 studies of dabigatran (Pradaxa, Boehringer Ingelheim) vs. vitamin K antagonists and 18 studies of apixaban (Eliquis, Bristol-Myers Squibb/Pfizer) vs. vitamin K antagonists.
The analysis included safety, defined as intracranial hemorrhage, effectiveness, defined as ischemic stroke, and nonpersistence, defined as a break in treatment of 60 days or longer.
Compared with vitamin K antagonists, rivaroxaban was associated with lower risk for ischemic stroke (HR = 0.83; 95% CI, 0.75-0.93), intracranial hemorrhage (HR = 0.69; 95% CI, 0.52-0.9) and nonpersistence (HR = 0.62; 95% CI, 0.6-0.65), Craig I. Coleman, PharmD, professor of pharmacy practice at the University of Connecticut, and colleagues wrote.
Dabigatran was associated with reduced risk for ischemic stroke (HR = 0.8; 95% CI, 0.65-0.98) and intracranial hemorrhage (HR = 0.45; 95% CI, 0.36-0.58) but not for nonpersistence (HR = 0.91; 95% CI, 0.53-1.55) compared with vitamin K antagonists.
Apixaban compared with vitamin K antagonists conferred reduced risk for intracranial hemorrhage (HR = 0.41; 95% CI, 0.28-0.6) but not ischemic stroke (HR = 1.01; 95% CI, 0.87-1.17) or nonpersistence (HR = 1.08; 95% CI, 0.81-1.45), Coleman and colleagues wrote.
“Real-world evidence provides valuable information to help inform treatment decisions for patients, including those with nonvalvular atrial fibrillation,” Coleman said in a press release. “Our findings show that certain [direct oral anticoagulants], like rivaroxaban, are performing exceptionally well, and that physicians should feel confident prescribing them to prevent strokes that can often result in irreversible harm and even death.” – by Erik Swain
Disclosure s : Coleman reports he received grants and consultant fees from Bayer and Janssen. Please see the study for all other authors’ relevant financial disclosures.