A study published in The BMJ examines the safety of using direct oral anticoagulants as an alternative to warfarin for treating major bleeding.
Researchers studied three common DOACs — dabigatran, rivaroxaban and apixaban — and compared them with warfarin in patients with and without atrial fibrillation. They used data from two United Kingdom-based primary care databases and identified 196,061 patients who started or restarted anticoagulants between 2011 and 2016.
Of the 196,061 patients, 132,231 patients were taking warfarin, 7,744 dabigatran, 37,863 rivaroxaban and 18,223 apixaban. Around 53 percent were diagnosed with atrial fibrillation and 47 percent prescribed anticoagulants for other conditions. They monitored the patients for major bleeding that led to hospital admission or death, ischaemic stroke, venous thromboembolism and death from any cause.
The researchers found:
1. Apixaban was associated with a lower risk of major bleeding in patients with and without AF as compared with warfarin.
2. Additionally, patients with AF prescribed dabigatran and patients without AF prescribed rivaroxaban had lower risk of brain bleeds as compared to patients prescribed warfarin.
3. However, rivaroxaban and low-dose apixaban were associated with increased risks of deaths from any cause in all patients when compared with warfarin.
Researchers cautioned against drawing firm conclusions about cause and effect from this study as it is an observational study. They did note, however, that the study shows that "the risk of major bleeding is lower in apixaban users regardless of the reason for prescribing, appearing to show apixaban to be the safest drug."
More articles on healthcare quality:
Staffing issues force Denver hospital to suspend transplant program: 7 things to know
Man sues South Carolina hospital for allegedly leaving surgical glove inside him after surgery
Joint Commission denies Baltimore hospital preliminary accreditation over issues with dialysis center