How safe and effective are new drugs for stroke prevention?
Mayo Clinic
For
decades, warfarin was the only oral blood thinner available to reduce
the risk of stroke for patients with atrial fibrillation. Warfarin use
is cumbersome, because it requires ongoing blood test to monitor the
effect and has numerous drug and food interaction. Now a number of
non–vitamin K antagonist oral anticoagulant (NOAC) drugs are available
for patients with atrial fibrillation and claim to revolutionize the
care for patients with atrial fibrillation. In a study published online
in CHEST Journal, Mayo Clinic cardiologist Peter Noseworthy, M.D., and
colleagues compared the effectiveness and safety of three NOACs
(dabigatran, rivaroxaban and apixaban). NOACs come with some benefits
over warfarin. They work quickly and clear the body quickly, and require
fewer monitoring blood tests. However, until now, the relative
effectiveness and safety of each was not well known. Dr. Noseworthy and
his research team hope this study will give clinicians valuable
information they can use in making decisions and communicating with
their patients.
Using the OptumLabs Data Warehouse, the researchers were able to compare thousands of patients using the three drugs to each other and determine the relative effectiveness and safety of each drug. Looking at medical claims data from October 2010 through February 2015, they compared three one–to–one matched cohorts of patients with non–valvular atrial fibrillation. The cohorts included 31,574 patients taking either rivaroxaban or dabigatran, 13,084 patients using apixaban or dabigatran, and 13,130 patients taking apixaban or rivaroxaban. Effectiveness was determined by whether patients suffered stroke or systemic embolism. Safety was determined by whether they had a major bleeding episode while on the treatment. The researchers found no significant difference between the three NOACs for risk of stroke or systemic embolism. However, they found that patients taking apixaban were less likely to experience major bleeding than those taking dabigatran or rivaroxaban. Rivaroxaban also had a higher risk of major bleeding and intracranial bleeding, compared to dabigatran.
Using the OptumLabs Data Warehouse, the researchers were able to compare thousands of patients using the three drugs to each other and determine the relative effectiveness and safety of each drug. Looking at medical claims data from October 2010 through February 2015, they compared three one–to–one matched cohorts of patients with non–valvular atrial fibrillation. The cohorts included 31,574 patients taking either rivaroxaban or dabigatran, 13,084 patients using apixaban or dabigatran, and 13,130 patients taking apixaban or rivaroxaban. Effectiveness was determined by whether patients suffered stroke or systemic embolism. Safety was determined by whether they had a major bleeding episode while on the treatment. The researchers found no significant difference between the three NOACs for risk of stroke or systemic embolism. However, they found that patients taking apixaban were less likely to experience major bleeding than those taking dabigatran or rivaroxaban. Rivaroxaban also had a higher risk of major bleeding and intracranial bleeding, compared to dabigatran.
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