Patients with the heart condition valvular atrial fibrillation (Afib) who used direct oral anticoagulants (DOACs) for the first time had a lower risk of experiencing a stroke, embolism, or major bleeding than users of warfarin scientists have found. The research provides more evidence that DOACs are safer than warfarin and could help improve anticoagulant prescribing and outcomes for Afib patients.
Warfarin is the most commonly prescribed drug to prevent stroke in patients with Afib, but the medicine isn’t without its problems. There are limitations on how much of the drug can be used without causing damage (its therapeutic window), variability in how patients respond to a set dose and negative interactions with certain foods and drinks. Warfarin is considered one of the most difficult and dangerous drugs used today.
DOACs have been developed as an alternative to warfarin and have been approved for use in the USA and the UK for over ten years. While doctors are increasingly prescribing DOACS as an alternative treatment for Afib patients, there is limited data about their effectiveness and safety.
To compare the effectiveness of both types of drug, researchers from the Perelman School of Medicine at the University of Pennsylvania assessed data from over 56,000 patients prescribed DOACS and warfarin with valvular AF. “Use of DOACs (vs warfarin) was associated with lower risk for ischemic stroke or systemic embolism,” the authors found.
“The results for the effectiveness and safety outcomes remained consistent for apixaban and rivaroxaban,” the authors found. Results for dabigatran showed a positive impact on reducing major bleeding but not for effectiveness in reducing the risk of stroke or systemic embolism.
DOACs and warfarin both work to “thin” the blood, reducing the risk of blood clots and resulting complications. The study adds to a growing body of evidence that suggests DOACs are a safer alternative for all patients. “These findings should help to guide anticoagulant choices for patients with valvular atrial fibrillation,” the authors state.
One of the most significant challenges doctors face when prescribing medicines is understanding how patients will react to them. Anticoagulants, such as warfarin, can be highly effective in the proper doses but dangerous in the wrong amounts.
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You can read the paper, Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation, here.