Anti-coagulant efficacy

[Sambaqui]

It is now some years since the introduction of the newer anti-coagulants - rivaroxaban, dabigatran, apixaban and edoxaban. Does anyone know of any follow-up research that confirms their efficacy in preventing strokes? I'm thinking of research that might have been carried out by independent medical bodies and not by the drug manufacturers. I'd also be curious to know of any investigation of the long-time side effects of slowing the rate of coagulation.

[BobD Volunteer]

Not sure of your motives here. These drugs work. Period. AF makes us five times more at risk of stroke than those without it.

Anticoagulants of all types reduce this risk by approx 70% or more .

Regarding long term anticoagulation warfarin has been around for some seventy years and widely used and apart from the well reported side effects such as hair loss or brittle nailes in a few patients has been largely trouble free if properly monitored,.

The DOACs probably have not been around long enough for that sort of degree of comfort but most people seem happy enough on them.

[Sambaqui in reply to BobD]

Thanks for your response, BobD, and your confidence in NOACs. I've probably been reading too many books and articles about pharmaceutical companies recently, mostly I have to say in relation to drugs designed to treat depression and other mental health conditions. In this area, it seems to be common knowledge that some companies have made serious distortions and omissions relating to trial results in order to boost sales. When it comes to AF, as you point out, warfarin has been around for a very long time and has a good track record. I shall put my trust in the same being true for DOACs. Thanks again.

[MarkS]

In "real world" trials carried out by independents, warfarin does come out as slightly better than the NOACs, e.g.:

ncbi.nlm.nih.gov/pmc/articl...

however NOACs still work OK, just not quite as effectively as well controlled warfarin.

There aren't any long term issues with warfarin slowing the coagulation effect, the NOACs haven't been around long enough to confirm they're OK, but I wouldn't expect it to be an issue.

[Sambaqui in reply to MarkS]

Thanks for this Mark. It's good to read something backed by independent analysis. I guess only time will tell in terms of long term issues.