In a recent study lead by UCL researchers, a thorough assessment of direct oral anticoagulants (blood thinners), frequently prescribed for irregular heartbeats, has shown the medication linked to the lowest risk of bleeding.
According to the research published in the Annals of Internal Medicine, apixaban, one of the two most popular direct oral anticoagulants (DOACs), had the lowest risk of gastrointestinal bleeding while performing similarly in terms of preventing strokes and other side effects.
For persons with atrial fibrillation, a disorder that affects over 33 million people worldwide and causes slow or irregular heartbeats, DOACs are used to avoid strokes. Compared to warfarin, the old standard of care, they are now more widely used since they require less follow-up monitoring (which was especially helpful during the COVID-19 pandemic) and have fewer risks for adverse effects.
The four most popular DOACs were examined in the new study for efficacy and adverse effect risk. In the US, UK, France, Germany, and other countries, they examined data from more than 500,000 new DOAC users, including 281,320 users of apixaban, 61,008 users of dabigatran, 12,722 users of edoxaban, and 172,176 users of rivaroxaban.
They discovered that the results for ischemic stroke, brain bleeds, and overall mortality were comparable among all four medicines, but they did find a difference in the risk of gastrointestinal bleeding, which is one of the most prevalent and worrisome side effects of DOACs.
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 randomized controlled trials.
Dr. Wallis Lau
When directly compared to each of the other three DOACs, the study found that apixaban had a risk of gastrointestinal bleeding that was between 19 and 28 percent lower.
When the researchers only considered data from those over the age of 80 and those who had chronic kidney illness, two populations that are frequently underrepresented in clinical trials, they discovered that their conclusions were still valid.
Co-lead author Dr. Wallis Lau (UCL School of Pharmacy) 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 randomized 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.”
