Study Compares NOACs for Preventing Bleeding and Stroke

Apixaban may be associated with a lower risk of bleeding than dabigatran and rivaroxaban in patients with atrial fibrillation (AF), according to a new review of the 3 non-vitamin K antagonist oral anticoagulants (NOACs).

Recent clinical trials have suggested that some NOACs may be as effective as warfarin in preventing strokes in patients with AF. However, little data are available about how NOACs compare with each other in regard to safety and efficacy.
______________________________________________________________________________________________________________________________________________________RELATED CONTENT
Bleeding Risk Lower with New Oral Anticoagulants vs Warfarin
Are Novel Oral Anticoagulants Safe Alternatives to Warfarin?
______________________________________________________________________________________________________________________________________________________

To evaluate stroke and bleeding risks, the researchers analyzed medical claims data from patients with nonvalvular AF who were taking dabigatran, rivaroxaban, and/or apixaban from October 1, 2010, to June 30, 2015.

Of the patients included in the study, 31,574 were taking either rivaroxaban or dabigatran, 13,084 were taking either apixaban or dabigatran, and 13,130 were taking apixaban or rivaroxaban.

The researchers tracked the occurrence of stroke or systemic embolism to determine efficacy and tracked major bleeding episodes to determine safety.

Results showed that the risk of stroke or systemic embolism was similar among the 3 medications.

Apixaban was less likely to cause major bleeding than dabigatran or rivaroxaban, whereas rivaroxaban was linked to a higher risk of major bleeding and intracranial bleeding compared with dabigatran.

“Dabigatran, rivaroxaban, and apixaban appear to have similar effectiveness whereas apixaban may be associated with lower bleeding risk and rivaroxaban with elevated bleeding risk,” the researchers concluded.

—Amanda Balbi

Reference:

Noseworthy PA, Yao X, Abraham NS, Sangaralingham LR, McBane RD, Shah ND. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in non-valvular atrial fibrillation [published online September 28, 2016]. Chest. dx.doi.org/10.1016/j.chest.2016.07.013.