Direct Oral Anticoagulants vs. Warfarin for Reducing Stroke, Major Bleeding

Caitlyn Fitzpatrick

Compared with warfarin, are direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, better at reducing stroke and major bleeding risks in patients with non-valvular atrial fibrillation? Alpesh Amin, MD, professor of medicine at the University of California, Irvine breaks it down at ACC 2017 in Washington, District of Columbia.

Warfarin used to be the only option doctors had for treating their patients for non-valvular atrial fibrillation. The introduction of direct oral anticoagulants (DOACs) changed all of that, however, researchers are still analyzing safety and efficacy profiles.

New study results comparing stroke and major bleeding outcomes with DOACs and warfarin were revealed at the 66th Scientific Session of the American College of Cardiology (ACC 2017) in Washington, District of Columbia. Principal Investigator Alpesh Amin, MD, professor of medicine at the University of California, Irvine broke down the data with MD Magazine at the conference.

The 2 million Medicare patients in the original cohort dwindled down to 186,000 by taking various factors, such as pregnancy and singular DOAC use, into consideration. Of those patients, 51% were on warfarin, 28% were on rivaroxaban (Xarelto/Janssen), 11% were on apixaban (Eliquis/Bristol-Myers Squibb and Pfizer), and 9% were on dabigatran (Pradaxa/Boehringer Ingelheim).

Apixaban and dabigatran was linked to statistically significant decreases in stroke risk. Rivaroxaban also decreased the risk of stroke, but it was not statistically significant. When it came to major bleeding, both apixaban and dabigatran substantially decreased the risk, however, rivaroxaban increased the risk.

“The bottom line is that the one drug that seemed to have statistical significance in terms of reduction of stroke and reduction of major bleeding compared to warfarin was apixaban,” Amin said.

>>> More Coverage from ACC 2017