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DOACs safer than warfarin for treating blood clots, says study

Newer anticoagulant drugs are safer than warfarin for treating serious blood clots, a study has found.

The DOACs carried a reduced risk of major bleeding when compared to warfarin, providing reassurance about their safety, researchers have said.

The study was carried out by primary care researchers at the University of Nottingham and included just under 200,000 patients who either did or didn’t have atrial fibrillation who were taking either warfarin or one of the DOACs between 2011 and 2016.

Patients were followed from the time of their first prescription until they either experienced an outcome of interest or stopped treatment, switched treatment or left their practice.

The researchers found that when compared to warfarin, apixaban was associated with between a 40 and 44% lower risk of major bleeding in patients with or without AF. Apixaban and dabigatran were associated with lower risk of intracranial bleeding in patients with AF and rivaroxaban was associated with lower risk of intracranial bleeding in patients without AF.

The paper said: ‘Anticoagulants are prescribed for a wide range of indications although the adverse events have been studied mostly in patients with atrial fibrillation.

‘Our study has shown that the risk of major bleeding is lower in patients taking apixaban regardless of the reason for prescribing. This was most pronounced for intracranial bleeding in patients with atrial fibrillation and for gastrointestinal bleeding in patients without atrial fibrillation, appearing, in general, to show apixaban to be the safest drug.’

The research builds on the findings of a 2017 study that found similar levels of bleeding risk and all-cause mortality in patients prescribed DOACs or warfarin for VTE.

BMJ 2018; available online 4th July