Concerns about rivoroxaban and dabigatran doubling risk of acute myocardial infarction

[Goldfish_]

See post below regarding stopping aspirin

onlinelibrary.wiley.com/doi...

[dedeottie]

Thanks, I can access it now. Apixaban seems to be deemed o.k. .I suppose that is something! I will watch for further studies. Interesting.

[Goldfish_ in reply to dedeottie]

The only Noacs in this study were dabigatran and rivoroxaban. Apixaban was not part of this one.

[Vanna-C]

After careful reading, there does not seem to be sufficient numbers used to make a decision one way or another. Headline promises more than the article gives, as often happens!

[Goldfish_ in reply to Vanna-C]

Some 30.000 patients with af and over 1000 on Noacs. The paper stated there was insufficient to distinguish between rivoroxaban and dabigatran.

[CDreamer]

Thank you for posting - I guess this was the report mentioned in the Daily Mail.

I do think statistical studies like this alarms us and it is very hard for us to judge the personal risk versus benefit numbers (and they are numbers not certainties) and I often I feel between a rock and a hard place, not only on this subject but just about every drug I am asked to take :- Wafarin, Dabigatran, Asprin, Flecainide, Bisoprolol, Steroids, Statins, Mycophenolate and Pyridostigamine - but what is the alternative?

At the moment some of above are increasing my QOL and I am resigned to dying (hopefully not quite yet) whilst others pose a larger risk than benefit. Personally I would like to stick to the Apixaban because I have no known side effects, which is a lot more than I can say for some of the others.

Until personalized medicine prevails I guess we will just have to roll the dice.

[Finvola]

Thank you for posting this link, Goldfish. As the NOAC's are such a relatively new medication, long term side effects were always yet to be established with certainty.

Is my reading of the tables correct that the incidence of MI in those with medium CHADS score taking warfarin was 0.25% and rivoroxaban was 0.5%? Although this is double the risk, it is still a small risk - and it needs to be considered in proportion.

No doubt further studies will follow . . .

[Hidden in reply to Finvola]

Phew thank goodness don't want any more risks!

[rosyG]

Goldfish, what is the risk of MI do you think ( on Apixaban- I know it's not mentioned but presumably same as other DOACS intervening at same point on clotting process??))

[MarkS]

That's a very interesting study that builds on previous evidence. A risk of higher heart attacks was identified in the Rely trial for dabigatran, though subsequent research by the makers tried to invalidate that.

It would appear that warfarin actually has a protective effect, rather than the DOACs having a negative effect. Nevertheless it seems that this is an additional reason for staying on warfarin provided you can remain in range.

Of note too is that as well as the DOACs having twice the rate of heart attacks as warfarin, so did aspirin. I thought aspirin should have protected against heart attacks, but that doesn't seem to be the case. All the more reason for not using aspirin with AF.