“Overall, our results support the use of the new oral anticoagulants as alternatives to warfarin for long-term anticoagulation therapy in patients with AF,” conclude Dr. Mark J. Eisenberg and colleagues at Jewish General Hospital in Montreal, Quebec, Canada, in their report in the American Journal of Cardiology online April 26.
To examine the long-term safety and efficacy of the new oral anticoagulants agents relative to warfarin in patients with AF, the authors searched the literature for relevant randomized controlled trials of at least 1 year in duration.
The team identified three trials that compared apixaban, dabigatran, and rivaroxaban to warfarin in a total of 44,563 patients. A meta-analysis showed that the risk of all-cause stroke and systemic embolism was significantly lower in patients randomized to a new anticoagulant than to warfarin (relative risk 0.78).
Similarly, anticoagulation with one of the new agents was associated with a significantly lower risk of ischemic/unidentified stroke (RR 0.87), hemorrhagic stroke (RR 0.45), all-cause mortality (RR 0.88) and vascular mortality (RR 0.87), Dr. Eisenberg and colleagues found.
While the risk of intracranial bleeding was significantly reduced with the new anticoagulants compared to warfarin (RR 0.45), the differences in risk of major bleeding (RR 0.88) and GI bleeding (RR 1.25) were not statistically significant, according to the report.
In discussing the results, the authors point out that patients taking warfarin in these studies were more likely to be within the therapeutic INR range than in real-world practice. “The safety and efficacy profiles of the new agents relative to that of warfarin may therefore be augmented when used outside the controlled clinical trial setting,” they suggest.