The non-vitamin K antagonist oral anticoagulants (NOACs) are safe and effective alternatives to warfarin, according to a new study from investigators in Denmark. In a database of more than 61,000 patients, the NOACs (dabigatran [Pradaxa], rivaroxaban [Xarelto], and apixaban [Eliquis]) were compared to warfarin in patients with atrial fibrillation. In an observational cohort study, more than half of the patients took warfarin, while nearly 13,000 took dabigatran, more than 7,000 took rivaroxaban, and 6,300 took apixaban. The NOACs were similar to warfarin in preventing ischemic stroke, although rivaroxaban was better than warfarin in preventing stroke or systemic embolism (3.0% vs. 3.3%, respectively; hazard ratio, 0.83; 95% confidence interval, 0.69-0.99). The annual risk of death and overall rate of bleeding was significantly lower with apixaban and dabigatran compared to warfarin, while rivaroxaban was comparable to warfarin for both endpoints. The authors concluded that the NOACs are safe and effective alternatives to warfarin in the routine care setting (BMJ 2016;353:i3189).
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