another interesting study indicating that the new oral anti-coagulants such as apixaban have a lower risk of major bleeding issues than products such as warfarin. however there are some caveats:
"The researchers point out that this is an observational study, so no firm conclusions can be drawn about cause and effect, and they outline some limitations, such as possible misclassification due to patients not taking their medication."
and from the BMJ:
"Overall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were, however, associated with increased risks of all cause mortality compared with warfarin."
So there is a puzzle in that we are advised(Apixaban advice) to reduce the dose at 80.Why do they give that adice if it is less effective overall?It does not make sense.
I think the title to this paper is most misleading. Bleeding is only one of the factors to be considered. The ultimate one is mortality.
If you go into the detailed paper and look at the mortality data (scroll to the bottom of fig 3) you find, that for AF sufferers compared with warfarin, dabigatran has similar mortality, rivaroxaban about 20% higher and for apixaban around 25% higher.
Then look at table 4 for for non-AF sufferers (who use the drugs to prevent clotting), the rates are 15% higher mortality for dabigatran, around 50% higher for Riveroxaban and Apixaban.
Even on the ischaemic stroke figures, Apixaban came out about 10% worse than warfarin.
Also there was no analysis of Time in Therapeutic Range (TTR) for warfarin, which is needed to fully understand the results.
I am fairly new to this site and am going back to my Gp on Monday. I saw one last week who advised me not going on to anticoagulants because of the haemorrhage risk! I bruise easily and when initially put on aspirin as a precaution prior to being diagnosed with AF, I had massive bruises on my arms and legs where I’d knocked into furniture......I tend to dash about a bit doing things and am trying to stop this! I’m really concerned about having a stroke as I’m 69,female and on amlodipine anti hypertension drug as a calcium channel blocker which has reduced irregularities a lot but not stopped them completely. I’d had a few high blood pressure readings prior to AFib diagnosis but BP was usually 140/70 or thereabouts. Bisoprolol was stopped cos I felt so bad on it. I want advice as to whether I should push for anticoagulants please before I see GP on Monday. As an added extra I’m on medication and have had major surgery etc etc for Breast cancer. Thank you in advance.
only you can resolve this with your GP - we cannot comment as we are not medically trained. however for those with AF, anticagulants are the way forward as a means of reducing the risk of stroke as an effect of AF.
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