Few more trials

[Ozchick]

This might be of interest to those a bit cautious of trialling NOAC's. The full link is here bmj.com/content/359/bmj.j4323 but I'm nt sure if you're able to open it. (some of the other links I've posted don't always work without a sign in).

New anticoagulants are not associated with an increased risk of major bleeding

According to a study published in the BMJ, treatment with direct oral anticoagulants (DOACs), compared to warfarin, is not associated with an increased risk of major bleeding or all-cause mortality.

For the study, researchers examined data from 59,525 adults with a new diagnosis of venous thromboembolism and prescription for a DOAC or warfarin within 30 days after diagnosis. Participants were followed up for 85 days on average. Hospital admissions or emergency room visits due to major hemorrhage and all-cause deaths were recorded up to 90 days after starting treatment.

The authors observed that the risk of major bleeding was similar for DOACs when compared to warfarin. No difference in risk of death was observed between the two treatment groups. The results remained unchanged after further analysis, including when a longer follow-up period (180 days) was used. The results were consistent for patients with and without chronic kidney disease in all age groups and for both men and women.

The authors said further studies are needed to understand the safety of DOACs in the long term and in patients with advanced chronic kidney disease.

Source: BMJ.

[HollyHeski Administrator]

Thank you for posting - I opened link fine.

Thing to remember though, although they are close, there is not a reversal yet for DOACs for bleeding, where as warfarin does have vitimin k.

So this study does not cover trauma cases, but does reassure short term safety with DOACs / warfarin.

[Ozchick in reply to HollyHeski]

There is now a reversal agent-if you don't want to read the whole article click on the short video in the link which explains how it works. nejm.org/doi/full/10.1056/N...

While I agree that clotting is the biggie for us - if you need emergency surgery or are in a serious car accident there is still the need for reversal. For anything non urgent you stop the meds 24-48 hours and recommence after 6 hours. For me it's a life changer and TBH if you are in an emergency situation and bleeding out (eg gunshot, car crash etc) I'm not sure any reversal agent will be there quick enough to save you!

[HollyHeski Administrator in reply to Ozchick]

Hi, I agree, the new DOACs are a life saver for many. And yes our problem is clotting!

Andexanet, is still being studied, I am not aware of this drug being licenced yet in the uk. I will do some research with A & E, ambulance crews and heamatologists to see where we are with reversals.

Again thanks for reports.

[Ozchick in reply to HollyHeski]

It is approved for reversal of Dabigatran in Australia but cost around $3k a pop! I will try not to have a bleed in the near future! I see a drug for the other NOAC's in the near future. These anti-coags have been around since 2011 so I feel relatively 'safe' in taking them even though they are used mainly for AF and other diseases.

[Tucson]

I think clotting is a bigger concern than bleeding.

[KellyInTexas Administrator in reply to Tucson]

Exactly what I was thinking.

This is the concern for APS , but excellent news for other normal folks who clot without APS.

But it’s working for Oz Chick! ( can’t tell you again how happy this makes me! And it’s allowing her to go on a fantastic holiday- still waiting to hear where she decides to go!!!! Sweden? Norway? .. she was leaning this direction- I’m so excited for her!!! She can hit both countries! And have coffee with Kerstin in Gamla Stan in Stockholm... I think I just talked myself into crashing this vacay- better grab my prescription of Xeralto!😂❤️😂❤️☕️