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DTB review of newer anticoagulants highlights contraindications and interactions

Treatment with newer oral anticoagulants apixaban, dabigatran and rivaroxaban results in similar or better mortality and vascular outcomes compared with warfarin, but prescribers should be aware of the contraindications and drug interactions associated with them. This is the conclusion of a new review from the Drug and Therapeutics Bulletin, which examines existing evidence on apixaban and rivaroxaban.

Both drugs are licensed for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation and one or more risk factors, including being aged 75 years or older, prior stroke, transient ischaemic attack, hypertension, diabetes mellitus and heart failure.

The drugs are particularly effective in reducing instances of haemorrhagic stroke compared with warfarin, according to several studies summarised in the review. However, careful renal assessment is required before treatment, and a series of contraindications have recently been applied to all three medicines because of the risk of serious haemorrhage, says the DTB.

The review points out that there are no head-to-head trials comparing any of the newer oral anticoagulants, which means it is not possible reliably to differentiate between them.

Satinder Bhandal, anticoagulation consultant pharmacist at Buckinghamshire Healthcare NHS Trust, told PJ Online: “It is excellent we now have alternative drug classes to vitamin K antagonists for anticoagulation, especially in atrial fibrillation patients, who by and large are an elderly group, many of whom struggle with the monitoring and variable dosing requirements of warfarin.” However, she added that the risks of bleeding and other side effects, which are different for each agent, must always be assessed regardless of anticoagulant choice.

• This article was amended on 13 January 2014 to include a comment from Satinder Bhandal.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11132691

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