Far be it for me to question the Food & Drug Administration regarding
their decision over a year ago to approve two new oral anticoagulants for use in preventing stroke in atrial fibrillation. But as I noted last week, a
study was just published in the Archives of Internal Medicine concluding that these
new oral anticoagulants increased risk of bleeding in patients prescribed anti-platelet agents in response to an acute coronary syndrome.
As you know, life isn't always that simple & clear cut as a
study was published last week in the British Medical Journal in which the
authors concluded that these very same new oral anticoagulants did not increase risk of bleeding compared to traditional vitamin K antagonist while demonstrating similar event reduction & all-cause mortality when used to treat acute venous thromboembolism.
Why the difference? This time, the authors analyzed data from 9 studies comprised of 16,701 participants regarding effectiveness and 16,611 regarding safety when used for treatment of acute venous thromboembolism and prevention of same. In fact, use of rivaroxaban was associated with lower risk of bleeding.
Bottom line: assuming one survives the wallet biopsy, these new oral anticoagulants are safe for use in treating DVT but not in preventing same in the immediate post-ACS period of time while taking an anti-platelet agent, too. Ah, the devil is in the details.
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Dr. James Meschino