The results of multiple randomized controlled trials have established that the direct oral anticoagulants (DOACs) are at least as effective as warfarin for the prevention of stroke or systemic embolism in patients with atrial fibrillation and for the prevention of recurrence in patients with venous thromboembolism, while producing similar or lower rates of major bleeding.
- Southworth M.R.
- Reichman M.E.
- Unger E.F.
Dabigatran and postmarketing reports of bleeding.
N Engl J Med. 2013; 368: 1272-1274
2Nonetheless, DOACs are still associated with serious bleeding. The lack of a specific antidote has raised concerns about the inability to promptly reverse their anticoagulant effect in patients with major bleeding and in those who require emergency surgery. Clinicians are worried that the lack of a specific antidote will lead to adverse outcomes when these drugs are used outside of the controlled environment of a randomized trial.
- Sardar P.
- Chatterjee S.
- Wu W.C.
- et al.
New oral anticoagulants are not superior to warfarin in secondary prevention of stroke or transient ischemic attacks, but lower the risk of intracranial bleeding: insights from a meta-analysis and indirect treatment comparisons.
PLoS One. 2013; 8: e77694
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- Dabigatran and postmarketing reports of bleeding.N Engl J Med. 2013; 368: 1272-1274
- New oral anticoagulants are not superior to warfarin in secondary prevention of stroke or transient ischemic attacks, but lower the risk of intracranial bleeding: insights from a meta-analysis and indirect treatment comparisons.PLoS One. 2013; 8: e77694
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Published online: January 27, 2014
Accepted: January 23, 2014
Received: December 16, 2013
See page 383 for disclosure information.
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.