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The Controversy Continues Again: which Direct Anticoagulant is More Effective and Safe when Administered to Patients with Atrial Fibrillation?

https://doi.org/10.20996/1819-6446-2020-08-09

Abstract

The data from the observational study of M. Fralick et al. were analyzed in the article. The authors analyzed a large database of patients with atrial fibrillation and concluded that rivaroxaban is inferior to apixaban in its ability to prevent ischemic stroke and systemic embolism and is more likely to cause bleeding. Serious methodological defects of the analysis take place. No statistical methods are capable of correcting the absence of such important information in the database as the doctor's motives for prescribing a particular drug, as well as the patient's adherence to taking it. It is also noted that the patients included in the study, according to clinical characteristics, did not correspond to the typical population of patients with atrial fibrillation. The author considers the conclusions made in the mentioned work to be unauthorized.

About the Author

S. Yu. Martsevich
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Sergey Yu. Martsevich – MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy

Petroverigsky per. 10, Moscow, 101990



References

1. Martsevich S.Yu., Kutishenko N.P. Randomised Clinical Trials and Observational Studies: the Ratio in the Hierarchy of Evidence of the Efficacy of Drugs. Rational Pharmacotherapy in Cardiology. 2016;12(5):567-73 (In Russ.) DOI:10.20996/1819-6446-2016-12-5-567-573.

2. Martsevich S.Y., Lukina Y.V., Kutishenko N.P. Once again about the hierarchy of evidences in medicine or whether it is possible to choose the most effective and safe drug with the help of observational studies. Rational Pharmacotherapy in Cardiology. 2017;13(2):270-4 (In Russ.) (In Russ.) DOI:10.20996/1819-6446-2017-13-2-270-274.

3. Harris M., Taylor G., Jackson D. Clinical evidence made easy. Banbury: Scion Publishing Ltd.; 2014.

4. Wang D., Bakhai A., eds. Clinical trials. A practical guide to design, analysis and reporting. London: Remedica Publishing; 2006.

5. Camm J., Fox K., Peterson E. Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention. Europace. 2017;0:1-11. DOI:10.1093/europace/eux086.

6. Fralick N., Colacci M., Schneeweiss S., et al. Effectiveness and safety of apixaban compared with rivaroxaban for patients with atrial fibrillation in routin practice. A cohort study. Ann Intern Med. 2020;172:463-73. DOI:10.7326/M19-2522.

7. Steinberg B., Shrader P., Thomas L., et al. Off-label dosing of non-vitamin K antagonist oral anticoagulants and adverse outcomes. J Amer Coll Cardiol. 2016;68:2597-604. DOI:10.1016/j.jacc.2016.09.966.

8. Connolly S.J., Ezekowitz S.J., Ysuf S., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51.

9. Patel M.R., Mahaffey K.W., Garg J., et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91. DOI:10.1056/NEJMoa1009638.

10. Granger C.B., Alexander J.H., McMurray J.J., et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:98-92. DOI:10.1056/NEJMoa1107039.

11. Martsevich S.Yu., Navasardyan A.R., Zakharova N.A., Lukyanov M.M. New oral anticoagulants: can the results of international controlled trials with these drugs be transferred to Russian patients? Cardiovascular Therapy and Prevention. 2015; 14: 48-52 (In Russ.) DOI:10.15829/1728-8800-2015-5-48-52.

12. Connolly S., Eikelboom J., Joyner C., et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806-17. DOI:10.1056/NEJMoa1007432.


Review

For citations:


Martsevich S.Yu. The Controversy Continues Again: which Direct Anticoagulant is More Effective and Safe when Administered to Patients with Atrial Fibrillation? Rational Pharmacotherapy in Cardiology. 2020;16(4):635-637. (In Russ.) https://doi.org/10.20996/1819-6446-2020-08-09

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)