Are Novel Oral Anticoagulants Safe Alternatives to Warfarin?

Non-vitamin K antagonist oral anticoagulants (NOACs) are safe and effective alternatives to warfarin in regular clinical practice, with some having lower risk of major bleeding than warfarin, according to the results of a recent study.

To compare the effectiveness and safety of the NOACs dabigatran, rivaroxaban, and apixaban with warfarin, researchers conducted an observational cohort study involving 61,678 patients with nonvalvular atrial fibrillation who had never taken NOACs.
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When the researchers restricted the analysis to ischemic stroke, NOACs were not significantly different than warfarin, with rivaroxaban being associated with lower annual rates of stroke or systemic embolism, and dabigatran and apixaban not being significantly different than warfarin.

Mortality risk and risk of bleeding were significantly lower with apixaban and dabigatran compared with warfarin, but not with rivaroxaban.  

“All NOACs are generally safe and effective alternatives to warfarin in a clinical care setting. For ischemic stroke, our weighted analysis suggests no significant differences between the NOACs and warfarin,” the researchers concluded. “The risks for death, any bleeding, or major bleeding were significantly lower for apixaban and dabigatran, compared with warfarin.”

—Michael Potts

Reference:

Larsen TB, Skjøth F, Nielsen PB, Kjældgaard JN, Lip GYH. Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study [published online June 16, 2016]. BMJ. doi: http://dx.doi.org/10.1136/bmj.i3189.