New medication with significantly lower bleeding rate

Av Timofey Sovershaev
Postdoktor ved TREC

Direct oral anticoagulants (DOACs) are a new class of drugs that prevent excess blood clotting. They are widely used due to a number of advantages over the previous generation of drugs (Vitamin K antagonists – Warfarin / Marevan), namely – more controlled effects, no need to do regular blood test to adjust the dose and fewer complications. This study talks about the comparative safety of three of those drugs.

Most of the studies to date have focused on the benefits of DOACs when compared to Warfarin and did not compare the new drugs directly against one another. In this study, the authors examined how three of those drugs (rivaroxaban, dabigatran, apixaban) compare to each other in terms of the frequency of gastrointestinal bleedings, one of the most common bleeding complications in patients that use those drugs.

The authors identified over 40 000 patients that received prescriptions for one of the three DOACs available at the time – rivaroxaban, dabigatran and apixaban during 2010-2015. The patients were divided into three groups based on the drugs used in order to compare the risk of bleeding.

Their results indicate that overall incidence of GI bleedings dramatically increases with age, in agreement with previous studies.

Importantly, the authors show significant differences in the rate of GI bleedings between the different DOACs, with apixaban showing less bleedings across all ages, especially in patients over the age of 75.

The authors propose that their data may be valuable for doctors that prescribe DOACs, especially to elderly populations. Overall, this is the first direct comparison of bleeding safety of DOACs between one another. What is good, is that this study is based on “real-life” data, and not on the idealized clinical trial settings. The results may be promising, but still need verification in a different study.

Reference: Abraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND. Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study. Gastroenterology (2016).

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