Tag: DOAC

Categories : Cardiovascular DiseaseTags : Leave a comment

Apaxiban Has Lowest Gastrointestinal Bleeding Risk of Common DOACs

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A large-scale comparison of direct oral anticoagulants (DOACs), published in Annals of Internal Medicine, one of the two most common direct oral anticoagulants (DOACs), apixaban, has the lowest risk of gastrointestinal bleeding, with similar performance on stroke prevention and other side effects.

DOACs are used to prevent strokes for people with atrial fibrillation, a condition affecting over 33 million people worldwide. They have recently become gained popularity over warfarin, the previous standard treatment, as they do not require as much follow-up monitoring (which was particularly valuable during the COVID pandemic) and have less risk of side-effects.

For the new study, University College London researchers compared the efficacy and risk of side effects for the four most common DOACs. They reviewed data from more than 500 000 new DOAC users in the UK, France, Germany and the US, including 281 320 apixaban users, 61 008 dabigatran users, 12 722 edoxaban users, and 172 176 rivaroxaban users.

They found that all four drugs were comparable on outcomes for ischemic stroke, brain bleeds and all-cause mortality, while they did identify a difference in risk of gastrointestinal bleeding, which is one of the most common and concerning side effects of DOACs.

The study revealed that apixaban stood out as having lower risk of gastrointestinal bleeding, with 19-28% lower risks when compared directly to each of the other three DOACs.

The researchers found that their findings held true when looking at data only from those aged over 80, and those with chronic kidney disease, two groups that are often underrepresented in clinical trials.

Dr Wallis Lau (UCL School of Pharmacy), who jointly led the work along with her colleague Professor Ian Wong, said: “Direct oral anticoagulants have been prescribed with increasing frequency worldwide in recent years, but evidence comparing them directly has been limited. Our results indicate that apixaban may be preferable to other blood thinners because of the lower rate of gastrointestinal bleeding and similar rates of stroke, a finding that we hope will be supported by randomised controlled trials.

“As with all medications, potential risks and benefits can differ between people, so considering the full spectrum of outcomes and side effects will still be necessary for each individual patient.

Source: University College London

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Aspirin Plus Blood Thinners Isn’t Always Better

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A new study has confirmed that combining two different blood thinners doesn’t necessarily improve outcomes. 

The new publication examined the minimal pros and the serious cons of combining a daily aspirin with a drug from the newer class of direct oral anticoagulants (DOACs) which include apixaban, dabigatran, edoxaban and rivaroxaban.

Patients were taking DOACs to prevent strokes from non-valvular atrial fibrillation or for the treatment of venous thromboembolic disease (deep vein thrombosis or pulmonary embolism). The included patients lacked another reason to take aspirin, such as a recent history of a heart attack or having had a heart valve replacement. One-third of those taking DOACs

“The patients on combination therapy were more likely to have bleeding events but they weren’t less likely to have a blood clot,” said lead author Jordan Schaefer, MD, an assistant professor of internal medicine and a haematologist at the University of Michigan. “Therefore, it’s important that patients ask their doctors if they should be taking aspirin when they are prescribed a direct oral anticoagulant.”

Combination therapy with an anticoagulant and an antiplatelet may be appropriate for people who have had a recent heart attack, recent coronary stent placement or bypass surgery, prior mechanical valve surgery or known peripheral artery disease, among other conditions, according to co-author Geoffrey Barnes, MD, MSc, an assistant professor of internal medicine and a vascular cardiologist at the Michigan Medicine Frankel Cardiovascular Center.

For the others, “combination therapy may not be happening intentionally; rather, the addition of aspirin might get overlooked because it’s not in any one specialist or general care provider’s territory,” Prof Barnes said.

There are many situations where an aspirin and DOAC combination has been insufficiently studied, and Prof Schaefer added that they are planning a larger, lengthier study since there were insufficient blood clots during the study to assess aspirin’s potential benefit.

Profs Schaefer and Barnes had also previously reported increased adverse outcomes for patients receiving both aspirin and warfarin, which is not a DOAC.

Source: Medical Xpress

Journal information: “Adverse Events Associated with the Addition of Aspirin to DOAC Therapy Without a Clear Indication,” JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2021.1197