(HealthDay News) — Apixaban seems to be the safest direct oral anticoagulant (DOAC) compared with warfarin, according to a study published in The BMJ.
Yana Vinogradova, PhD, from the University of Nottingham in the United Kingdom, and colleagues conducted a prospective open cohort study to examine the correlations between DOACs and warfarin and the risks of bleeding, ischemic stroke, venous thromboembolism, and all-cause mortality. Data were included for 132,231 warfarin, 7744 dabigatran, 37,863 rivaroxaban, and 18,223 apixaban users without anticoagulant prescriptions for 12 months before study entry. The patients were subgrouped into those with and those without atrial fibrillation (103,270 and 92,791, respectively).
The researchers found that, compared with warfarin, apixaban was correlated with reduced risk of major bleeding and intracranial bleeding (adjusted hazard ratios, 0.66 and 0.4, respectively) and dabigatran was correlated with reduced risk of intracranial bleeding (adjusted hazard ratio, 0.45) among patients with atrial fibrillation. Patients taking rivaroxaban or on lower doses of apixaban had increased risk of all-cause mortality (adjusted hazard ratios, 1.19 and 1.27, respectively). Apixaban was correlated with reduced risk of major bleeding, any gastrointestinal bleeding, and upper gastrointestinal bleeding in patients without atrial fibrillation compared to warfarin (adjusted hazard ratios, 0.6, 0.55, and 0.55, respectively); reduced risk of intracranial bleeding was seen in association with rivaroxaban (adjusted hazard ratio, 0.54).
“Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin,” the authors write. “Rivaroxaban and low-dose apixaban were, however, associated with increased risks of all-cause mortality compared with warfarin.”
Vinogradova Y, Coupland C, Hill T, and Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ 2018; 362 doi: 10.1136/bmj.k2505 [Published online July 4, 2018]