There in an ongoing debate amongst medical professionals concerning the effectiveness and safety of warfarin in comparison to the non–vitamin K antagonist oral anticoagulants (NOACs)–such as Eliquis, Xarelto, Savaysa, and Pradaxa–for patients with atrial fibrillation.
According to the Healio Cardiology today article, “Merits of warfarin, newer oral anticoagulants for patients with AF debated,” those in favor of warfarin for stroke prevention in patients with atrial fibrillation argue that:
- The experience in patients spans decades.
- Dosing is once daily, unlike some of the newer drugs.
- It can be monitored, unlike the newer drugs.
- Reversing its effects is easy and the newer drugs either have a brand-new reversal agent or none at all.
- It is effective in patients with mechanical heart valves, unlike the newer drugs.
- It costs much less than the newer drugs, and lower cost benefits adherence.
However, those in favor of NOACs tout them as safer and more effective than warfarin, citing comparative studies of oral anticoagulants.
The Journal of the American Heart Association published an article in June of 2016 discussing the findings of their comparative study. The study was conducted in order to examine the “Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation,” as explained by the article’s title.
Here is a brief summary of the study’s findings concerning the effectiveness of these oral anticoagulants in preventing stroke or systemic embolism:
- Eliquis (apixaban) was associated with reduced risk compared with warfarin
- Pradaxa (dabigatran) and Xarelto (rivaroxaban) were associated with a similar risk compared with warfarin
Here is a brief summary of the study’s findings concerning possible safety risks of these oral anticoagulants:
- Stroke or systemic embolism:
- Eliquis (apixaban) was associated with lower risk than warfarin
- Pradaxa (dabigatran) and Xarelto (rivaroxaban) were associated with a similar risk to warfarin
- Major bleeding:
- Eliquis (apixaban) and Pradaxa (dabigatran) were associated with lower risk than warfarin
- Xarelto (rivaroxaban) was associated with a similar risk to warfarin
- Intracranial bleeding:
- All NOACs were associated with a lower risk than warfarin
This article also warns that readers should keep the following information in mind when considering the results of this study, as well as similar ones:
Extrapolating findings from trials to general practice is especially challenging for anticoagulation therapies. Because anticoagulants are long‐term preventive medications that address no ongoing symptoms, adherence is substantially lower in observational studies than in clinical trials. Furthermore, appropriate dosing may be hard to achieve in clinical practice because of the complexity of real‐world settings. [Footnotes omitted.]
Gregg W. Stone, MD (professor of medicine at Columbia University, director of cardiovascular research and education at the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, and co-director of medical research and education at the Cardiovascular Research Foundation) states that “ensuring adherence with warfarin or a [newer oral anticoagulant] is more important than the issue of warfarin vs. a [newer oral anticoagulant].”
While the debate continues, perhaps one of the most important safety factors to examine when considering which oral anticoagulant to use is the availability of a reversal agent. While warfarin and Pradaxa have antidotes, Eliquis, Savaysa, and Xarelto do not.
The lack of FDA-approved reversal agents has led to the serious injury–and even death–of many patients taking NOACs. As such, a number of lawsuits against the manufacturers of these drugs have arisen. If you have taken Eliquis, Savaysa, or Xarelto and has suffered a serious bleeding event, please fill out the appropriate free case evaluation form, using the links below, to learn whether you may have a possible case.
- Free Eliquis Case Evaluation
- Free Savaysa Case Evaluation
- Free Xarelto Case Evaluation
- Free Pradaxa Case Evaluation
If you would like to learn more information about these drugs, please visit our website using the links below:
We will continue to monitor the medical literature concerning these particular oral anticoagulants and their future possible antidotes.
Written by: Heather Helmendach, Legal Assistant
Law Offices of Thomas J. Lamb, P.A.
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