Bleeding Risk Lower with New Oral Anticoagulants vs Warfarin

New oral anticoagulants are just as effective at providing stroke prevention as warfarin is but cause less intracranial bleeding, according to a study presented at European Society of Cardiology Congress 2016 in Rome, Italy.

Patients with atrial fibrillation are treated with non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (warfarin), both of which lower the risk of stroke but also increase bleeding risk.
_____________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Study: Warfarin May Not Stabilize Atrial Fibrillation Patients
Warfarin for Atrial Fibrillation Linked to Heightened Dementia Risk
_____________________________________________________________________________________________________________________________________________________________________

“There has been a need to investigate safety and effectiveness of NOACs versus warfarin in a ‘real world’ population and our Danish registries provide this opportunity,” the researchers explained.

In their study, the researchers compared the risk of stroke and intracranial bleeding associated with NOACs (dabigatran, rivaroxaban, and apixaban) vs warfarin in 43,299 patients with atrial fibrillation from a Danish nationwide administrative registry.

Roughly 42% of the patients were taking warfarin, while 29%, 16%, and 13% were taking dabigatran, apixaban, and rivaroxaban, respectively. Overall, stroke occurred in 1054 patients and intracranial bleedings in 261 patients.

At 1 year, the risk of stroke was similar (2.0%-2.5%) between NOACs and warfarin, but at 1 year the risk of intracranial bleeding was significantly lower in those taking dabigatran and apixaban (0.3%-0.4%) compared with warfarin (0.6%).

“The inclusion and exclusion criteria in our study were broadly similar for patients initiating NOACs or warfarin, and this gave a straightforward opportunity to directly compare the treatment regimens, which is in contrast to the randomized trials,” they concluded.

“In the future it would be exciting to see a head-to-head randomized trial performed to compare the different NOAC treatments in patients with atrial fibrillation.”

—Michael Potts

Reference:

Staerk L, Fosbol ELF, Bonde ANB, et al. Stroke and all cause mortality with non-vitamin K antagonist oral anticoagulation versus warfarin in atrial fibrillation: a nationwide study. Paper presented: at ESC Congress 2016; August 27, 2016; Rome, Italy.