This meta-analysis of 3 randomized trials of patients with Afib found the 3 new oral anticoagulants (dabigatran, apixaban, rivaroxaban) reduced stroke/embolism by 22% (RR 0.78, CI 0.67 to 0.92), hemorrhagic stroke by 55% (RR 0.45, CI 0.31 to 0.68), mortality by 12% (CI 0.82 to 0.95) and vascular mortality by 13% (RR 0.87, CI 0.77 to 0.98), compared to warfarin. Major and GI bleeding were not significantly different between the groups. This meta-analysis confirms early enthusiasm for these agents in preventing afib-associated stroke, although cost and lack of reliable antidotes will continue to raise concerns for using these agents in all patients (abstract)
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.