Study Finds Direct Oral AntiCoagulants (DOACs) Safe in A Fib Interview with:

Yana Vinogradova, PhD, Research Fellow Division of Primary Care, School of Medicine University of Nottingham Nottingham

Dr. Vinogradova

Yana Vinogradova, PhD, Research Fellow
Division of Primary Care, School of Medicine
University of Nottingham
Nottingham What is the background for this study? What are the main findings?

Response: Anticoagulants are prescribed for treatment and prevention of thrombosis and stroke but may lead to major bleeding.  Unlike the older drug warfarin, newer direct oral anticoagulants do not require regular blood tests but their safety was shown only in selected patients and in trial conditions.

The study found that Direct Oral AntiCoagulants (DOACs) are safer than warfarin in terms of bleeding risks with apixaban being the safest. What should readers take away from your report? 

Response: The report provides reassurance in safety of DOACs for patients with atrial fibrillation and for patients with other indications for prescribing. What recommendations do you have for future research as a result of this work?

Response: These medicines are still quite new and so researchers need to continue to look at their safety as more people take them over time. Further research is needed to understand the reasons for the increased risk of death associated with taking rivaroxaban and lower doses of apixaban as this wasn’t explained by the factors we could take account of in our study.  This will require a further investigation to look at exact causes of death. However the main message is reassuring regarding the reduced risk of serious bleeds with the newer anticoagulants especially apixaban compared with warfarin. 

Disclosure: The study was run at the University of Nottingham with support from National Institute for Health Research.  The authors have nothing to disclose.


Yana Vinogradova, Carol Coupland, Trevor Hill, Julia Hippisley-Cox. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ, 2018; k2505 DOI: 10.1136/bmj.k2505 



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