Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisSome new anticoagulant pills reduce cardiovascular events and serious bleeding
Sharma M, Cornelius VR, Patel JP, et al. Efficacy and Harms of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation and Secondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis. Circulation. 2015;132:194-204.
Review question
In people 75 years of age or older who have atrial fibrillation (abnormal heart beat) or venous thromboembolism (blood clots in veins), are new anticoagulant pills (blood thinners) safe and effective compared with other blood thinners such as warfarin?
Background
People with conditions such as atrial fibrillation or venous thromboembolism are at increased risk of developing (more) blood clots, which can increase the risk of lung embolism, heart attacks, or stroke. Doctors may prescribe anticoagulant pills to reduce the formation of blood clots. Warfarin, a vitamin K antagonist, is the anticoagulant pill prescribed most often. It requires careful monitoring by doctors and can cause serious bleeding. Newer anticoagulant pills are available and may be more effective, safer, and easier to take.
How the review was done
The researchers did a systematic review, searching for published studies up to June 2014. They found 12 randomized controlled trials with 31,418 people 75 years of age or older.
People in the trials had acute atrial fibrillation or venous thromboembolism.
New anticoagulant pills included dabigatran, rivaroxaban, apixaban, and edoxaban.
New anticoagulant pills were compared with warfarin or another vitamin K antagonist.
Outcomes were cardiovascular events (stroke or systemic embolism, venous thromboembolism), and serious bleeding.
What the researchers found
Compared with warfarin or another vitamin K antagonist:
- dabigatran, 150 mg, and apixaban reduced rates of stroke or systemic embolism;
- edoxaban, 60 mg, reduced rate of repeat venous thromboembolism; and
- apixaban and edoxaban, 30 and 60 mg, reduced rates of serious bleeding.
Conclusion
In people 75 years of age and older with acute venous thromboembolism or atrial fibrillation, some new anticoagulant pills reduce stroke or systemic embolism, repeat venous thromboembolism, or serious bleeding compared with vitamin K antagonists.
New anticoagulant pills vs vitamin K antagonists in people 75 years and older who have venous thromboembolism or atrial fibrillation
| Outcomes | Drug | Number of trials (number of people) | Rate of events with new anticoagulant pills | Rate of events with vitamin K antagonists | Effect of new anticoagulant pills at 3 to 34 months |
| Stroke or systemic embolism (SSE) | Dabigatran, 150 mg | 1 trial (4889 people) | 2.8% | 4.2% | About 14 fewer people out of 1000 had SSE |
|
| Dabigatran, 110 mg | 1 trial (4772 people) | 3.7% | 4.2% | No difference between groups* |
|
| Rivaroxaban | 1 trial (6164 people) | 4.1% | 5.0% | No difference between groups* |
|
| Apixaban | 2 trials (5746 people) | 2.8% | 3.9% | About 11 fewer people out of 1000 had SSE |
|
| Edoxaban, 60 mg | 1 trial (5668 people) | 4.9% | 5.9% | No difference between groups* |
|
| Edoxaban, 30 mg | 1 trial (5626 people) | 6.6% | 5.9% | No difference between groups* |
| Repeat venous thromboembolism | Dabigatran, 150 mg | 2 trials (529 people) | 1.2% | 1.8% | No difference between groups* |
|
| Rivaroxaban | 2 trials (1283 people) | 2.3% | 3.7% | No difference between groups* |
|
| Apixaban | 1 trial (749 people) | 1.8% | 3.6% | No difference between groups* |
|
| Edoxaban, 60 mg | 1 trial (1104 people) | 2.5% | 5.0% | About 25 fewer people out of 1000 had repeat venous thromboembolism |
| Serious bleeding | Dabigatran, 150 mg | 3 trials (4726 people) | 9.8% | 8.4% | No difference between groups* |
|
| Dabigatran, 110 mg | 1 trial (4114 people) | 9.2% | 9.0% | No difference between groups* |
|
| Rivaroxaban | 4 trials (7082 people) | 6.4% | 6.1% | No difference between groups* |
|
| Apixaban | 2 trials (6423 people) | 4.9% | 7.5% | About 26 fewer people out of 1000 had serious bleeding |
|
| Edoxaban, 60 mg | 1 trial (5668 people) | 7.5% | 9.1% | About 16 fewer people out of 1000 had serious bleeding |
|
| Edoxaban, 30 mg | 1 trial (5626 people) | 4.3% | 9.1% | About 48 fewer people out of 1000 had serious bleeding |
Related Topics
Glossary
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
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Related Web Resources
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Atrial fibrillation
Informed Health OnlineAtrial fibrillation is when the heart rate is abnormal, and usually too fast. Atrial fibrillation causes heart palpitations or feeling faint. There are different treatment options for atrial fibrillation; talk to your doctor about what would work best for you. -
Atrial fibrillation - Preventing strokes
Informed Health OnlineIn the long term, atrial fibrillation can increase the risk of stroke. Some people might be at greater risk for a stroke, depending on what other risk factors they have. A doctor might prescribe anticoagulant medication to lower this risk. -
Supraventricular tachycardia: Should I have catheter ablation?
OHRIThis patient decision aid helps people with heart rate problems with symptoms that bother them a lot and do not want to take medicine, or medicine has not worked decide on whether or not to have catheter ablation. It facilitates the process by comparing the benefits, risks, and side effects of both options.
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