November 30, 2016
While they may be comparable in terms of efficacy, safety remains a concern for those who switch from warfarin to other novel oral anticoagulants for stroke prevention, according to a study published in the Journal of Cardiology.
Drug Combo May Cause Bleeding for Patients With Atrial Fibrillation
NOACs a "reasonable" alternative to VKAs in cardioversion patients
There are a limited number of studies comparing novel oral anticoagulants with warfarin for stroke prevention in patients with non-valvular atrial fibrillation. Therefore, researchers led by Lindsay GS Bengston, PhD, Health Economics and Outcomes Research, Optum (Eden Prairie, MN), used matched data from US Market Scan Databases to compare how outcomes changed for patients with non-valvular atrial fibrillation depending upon whether they were treated with warfarin or one of two novel oral anticoagulants, dabigatran and rivaroxaban.
Among 145,666 patients included in the final analysis, 3301 received rivaroxaban, 109,447 received warfarin, and 32,019 were given dabigatran. In total, there were 225 cases intracranial bleeds, 1035 cases ischemic strokes, 958 incidents of myocardial infarctions, and 1842 cases of gastrointestinal bleeding identified.
Overall, rates for ischemic stroke were similar regardless of which treatment was used while those who initiated treatment with one of the novel oral anticoagulants experienced lower rates of intracranial bleeding compared with warfarin users. However, dabigatran was only associated with a lower rate of ischemic stroke in naïve users, not those who switched from another treatment, and was also associated with a higher rate of gastrointestinal bleeding, compared with warfarin users. The risk of stroke and bleeding were not significantly different between patients who received rivaroxaban and patients who received warfarin.
Researchers concluded that while the efficacy of novel oral anticoagulants were comparable to warfarin, more research is needed on the potential harms and benefits of switching from warfarin to dabigatran.—Sean McGuire