Four novel anticoagulants approved
Around one to two million people in Germany, mostly older people, suffer from atrial fibrillation. Although this form of cardiac arrhythmia is not immediately threatening, it does increase the risk of stroke in the long term. Many of those affected are prescribed long-term therapy with blood-thinning medication as a preventive measure. Until a few years ago, these were mostly so-called vitamin K antagonists, namely the active ingredients warfarin or phenprocoumon.
In the meantime, newer anticoagulants are increasingly being used instead: direct oral anticoagulants, or DOAC for short. Four active ingredients are approved in Germany: apixaban, dabigatran, edoxaban and rivaroxaban.
Active substance apixaban scores in large study
Of the four new drugs, apixaban appears to be the most effective and well tolerated in atrial fibrillation. A new clue provides a Study by researchers from Vanderbilt University in the US in the journal Jama.
It included data from nearly 600,000 elderly people with atrial fibrillation who were taking either apixaban or rivaroxaban. The investigation period was four years, the evaluation took into account many factors such as concomitant diseases and other medications. This is the first study with a very large database that directly compares two of the newer active ingredients.
Fewer strokes and bleeding with apixaban
Conclusion of the study: In the group of those who received apixaban, strokes occurred less frequently than in the comparison group – and also less bleeding, a typically feared side effect. According to the analysis, 13 to 14 out of 1,000 people who take apixaban suffer a serious problem such as a stroke or major bleeding every year, compared to around 16 out of 1,000 people who take rivaroxaban. Extrapolated to large population groups treated with the agents, the difference is very significant.
Other active ingredients only suitable to a limited extent
The study confirms evidence from previous research and supports the ratings in our drug database. There we rate apixaban better than the other members of the group: dabigatran, edoxaban and rivaroxaban. These three are only suitable to a limited extent in long-term use, for example in the case of atrial fibrillation.
Apixaban, on the other hand, is “also suitable” in this area of application. The active substance has not yet been tested as a long-term therapy under everyday conditions, which is why it does not get the top rating “suitable” in our drug evaluation. Tips on the correct use of DOAK and vitamin K antagonists can be found in our drug database under anticoagulants.
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Correct intake and concentration are crucial
Unlike drugs that are vitamin K antagonists, the coagulation of the newer drugs does not have to be checked regularly by measurements. Nevertheless, it is also extremely important for these active ingredients that their concentration in the blood is in the right range. If it is too high, the risk of bleeding increases. If it is too deep, there is a risk of vascular occlusions such as strokes.
Tipp: Take the remedies regularly and exactly as prescribed. Make sure that your doctor takes into account whether you are taking other medications and the status of your kidney function when making the selection and dosage. When restricted, DOAC may be less efficiently cleared, increasing their concentration in the blood and increasing the risk of bleeding. Kidney function can deteriorate with age. It should therefore be monitored regularly during the course of treatment.