In two medical study reports it seemed that Xarelto (rivaroxaban) was more likely to be involved in a serious bleeding event as an adverse reaction than was either Pradaxa (dabigatran) or Eliquis (apixaban).
Earlier this month the medical journal Chest published this article, “Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation”.
Also earlier this month, JAMA Internal Medicine published this article, “Stroke, bleeding, and mortality risks in elderly Medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation.”
We get these insights from this October 7, 2016 article, “More NOAC Comparisons See Higher Bleeding Risk With Rivaroxaban: Is the ‘Writing on the Wall’?”:
The two new studies [published in the medical journal Chest and JAMA Internal Medicine] come close on the heels of an analysis by Danish researchers comparing [Pradaxa (dabigatran)], [Xarelto (rivaroxaban)], [Eliquis (apixaban)], and warfarin. In that analysis, [Pradaxa (dabigatran)] and [Eliquis (apixaban)] were associated with a significantly decreased risk of ICH compared with warfarin, but [Xarelto (rivaroxaban)] was not, although all three [non-vitamin K antagonist oral anticoagulants (NOACs)] were as effective as warfarin at reducing stroke in atrial fibrillation patients….
To date there are no randomized head-to-head trials comparing the new agents, but that is about to change. [Laila Stærk, MD (Herlev and Gentofte University Hospital, Denmark), who presented that data at the recent European Society of Cardiology Congress 2016,] told TCTMD that a new prospective, cluster randomized trial has just been announced in Denmark that will involve “almost all” hospitals in the country. Designed to run for 4 years, each hospital will just use one of the four approved NOACs ([Pradaxa (dabigatran)], [Xarelto (rivaroxaban)], [Savaysa (edoxaban)], and [Eliquis (apixaban)]) for the period of 1 year, then the next the next year, and so forth. At the end of the 4-year period, every participating hospital will have 1 year’s experience with each of the approved NOACs, with follow-up to continue for several years thereafter. Dubbed DEN-NOAC, the trial will be led by Casper Bang, MD (Rigshospitalet, Copenhagen, Denmark).
Of course, we will continue to monitor the still-emerging safety issues surrounding Eliquis, Savaysa, and Xarelto.
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