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The New Blood Thinners in Atrial Fibrillation, Did They Keep Their Promise a Decade Later? And What About my Risky Older Patient?

Jacob Goldstein

A decade after the Randomized Controlled Studies (as RCT’s) on Direct Oral Anticoagulants as DOAC’s, or as called by other names as: NOAC’s (as novel oral anticoagulants or non- vitamin K dependent oral anticoagulants) or TSOAC (as target specific oral anticoagulants), have been published what have we learned? According to the metanalyses of those RCT’s (comparison to warfarin \ VKA and not a direct comparison) all of the DOAC’s are either superior to warfarin (dabigatran 150 mg bid, apixaban) or noninferior (rivaroxaban, edoxaban, dabigatran 110 mg bid) in the reduction of stroke. An unexpected but very important finding was that all are associated with a significant reduction (around 50% RRR) in intracranial hemorrhage compared to adjusted dose of warfarin. Another important outcome was their safety, being either noninferior to warfarin with respect to major bleeds (dabigatran 150 mg bid and rivaroxaban) or result even in a significant reduction in major bleeding (dabigatran only at 110 mg bid, edoxaban, and apixaban full dose).