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Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation : A Multinational Population-Based Cohort Study
CONCLUSION: Among patients with AF, apixaban use was associated with lower risk for GIB and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban. This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials.PRIMARY FUNDING SOURCE: None.PMID:36315950 | DOI:10.7326/M22-0511
Source: Annals of Internal Medicine - October 31, 2022 Category: Internal Medicine Authors: Wallis C Y Lau Carmen Olga Torre Kenneth K C Man Henry Morgan Stewart Sarah Seager Mui Van Zandt Christian Reich Jing Li Jack Brewster Gregory Y H Lip Aroon D Hingorani Li Wei Ian C K Wong Source Type: research

Using primary care data to assess comparative effectiveness and safety of apixaban and rivaroxaban in patients with nonvalvular atrial fibrillation in the UK: an observational cohort study
Conclusions Among patients with nonvalvular AFib, apixaban was as effective as rivaroxaban in reducing rate of stroke and safer in terms of major bleeding episodes. This head-to-head comparison supports conclusions drawn from indirect comparisons of DOAC trials against warfarin and demonstrates the potential for real-world evidence to fill evidence gaps and reduce uncertainty in both health technology assessment decision-making and clinical guideline development.
Source: BMJ Open - October 17, 2022 Category: General Medicine Authors: Jaksa, A., Gibbs, L., Kent, S., Rowark, S., Duffield, S., Sharma, M., Kincaid, L., Ali, A. K., Patrick, A. R., Govil, P., Jonsson, P., Gatto, N. Tags: Open access, Cardiovascular medicine Source Type: research

Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke
To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke —Reply
In Reply We agree that conclusions drawn from our observational cohort study should be interpreted within the context of the study design and its inherent limitations. One such limitation is the lack of granular data on the time of last NOAC dose. The GWTG-Stroke registry defines NOAC use as documentation that a patient was taking dabigatran, rivaroxaban, apixaban, or edoxaban within 7 days before hospital arrival. We attempted to overcome this limitation by including additional data from the ARAMIS registry.
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

Pharmacological Difference Between Platelet Aggregations in Cardioembolic Stroke Patients with Direct Oral Anticoagulants: A Pilot Study
Major hemorrhagic complication incidence in patients with arterial fibrillation (AF), and treated with direct oral anticoagulants (DOACs), is lower than in vitamin K antagonist-treated patients.1 –5 Additionally, among DOACs, the direct oral thrombin inhibitor (dabigatran) and direct oral factor Xa (FXa) inhibitors (apixaban and rivaroxaban) seem to affect the coagulation system differently, which could provide distinct clinical outcomes.6,7 The results from the US6 and Denmark8 cohort stu dies suggest there is a minute, but notable difference in major bleeding complication incidence between dabigatran and FXa inhibitors.
Source: Journal of Stroke and Cerebrovascular Diseases - May 3, 2022 Category: Neurology Authors: Masahito Nakazaki, Shinichi Oka, Hirotoshi Magota, Ryo Kiyose, Rie Onodera, Ryo Ukai, Yuko Kataoka-Sasaki, Masanori Sasaki, Osamu Honmou Source Type: research

Antiphospholipid Syndrome Diagnosed as a Result of the Occurrence of an Ischemic Stroke After a Successful Catheter Ablation of Atrial Fibrillation and Continuous Direct Oral Anticoagulants
We report a case of an ischemic stroke after a successful catheter ablation of atrial fibrillation (AF) and continuous oral anticoagulation therapy with direct oral anticoagulants (DOACs), which was the trigger for diagnosing antiphospholipid syndrome (APS). A 68-year-old woman underwent catheter ablation of persistent AF and continued oral anticoagulation with edoxaban at a dose of 30 mg once daily after the ablation procedure. An asymptomatic intracerebral hemorrhage was detected by brain computed tomography and magnetic resonance imaging one month post-ablation. Oral anticoagulation with dabigatran at 110 mg twice daily...
Source: International Heart Journal - January 31, 2022 Category: Cardiology Authors: Yumiko Haraguchi Kohki Nakamura Mitsuho Inoue Takehito Sasaki Kentaro Minami Shingo Yoshimura Shigeto Naito Source Type: research

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