How Effective Are New Drugs in Stroke Prevention?

For decades, warfarin was the only oral blood thinner available to reduce the risk of stroke for patients with atrial fibrillation.

Warfarin use requires ongoing blood tests to monitor its effect and has numerous drug and food interactions. Now a number of non-vitamin K antagonist oral anticoagulant (NOAC) drugs are available for patients with atrial fibrillation.

In a study published online in CHEST Journal, Mayo Clinic cardiologist Peter Noseworthy, MD, and colleagues compared the effectiveness and safety of three NOACs (dabigatran, rivaroxaban and apixaban).

“We have strong data from large randomized clinical trials which demonstrate that the new medications are at least as good as warfarin in preventing stroke in atrial fibrillation,” said Noseworthy. “However, the question many clinicals and patients are interested in is how do these medications compare to each other?”

“It’s unlikely that such a clinical trial would be performed in the near term,” he said. “Instead, we have performed an analysis of patients currently taking these medications in order to observe stroke and bleeding rates and make a comparison based on real-world clinical practice.”

NOACs come with some benefits over warfarin. They work quickly and clear the body quickly, and require fewer monitoring blood tests. However, until now, the relative effectiveness and safety of each was not well known. Noseworthy and his research team hope this study will give clinicians valuable information they can use in making decisions and communicating with their patients.

“Individual treatment decisions still are in the hands of the providers and their patients,” said Noseworthy. “However, these findings will help me treat my patients, and I hope will help my colleagues, as well.”

“These data sets were very large and show that apixaban users have less major bleeding incidents; whereas, rivaroxaban had higher likelihood of serious bleeding than either of the other two NOACs. Apixaban also seems to provide better results than warfarin,” he said.

Regardless of what sounds good, Noseworthy reminds patients, “Never stop taking prescribed medication without talking to your doctor.”

In addition to Noseworthy and Xiaoxi Yao, Ph.D., the research teams included: Neena Abraham, MD, Lindsey Sangaralingham, Robert McBane, MD,and Nilay Shah, Ph.D. All team members are from Mayo Clinic.