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Some cardiologists have said that Pradaxa and the other new drugs represent real advances over warfarin.
In a news release in November announcing the drug's approval in Europe, Bristol-Myers noted that Eliquis was the only drug in the group that has shown an advantage over warfarin in reducing the risk of stroke and dangerous blood clots, major bleeding and death.
Dabigatran, 150 mg twice a day, has shown superiority over warfarin with respect to its ability to prevent stroke with a lower rate of life-threatening bleeding complications; however, dabigatran has an increased risk of gastrointestinal bleeding [2].
The benefits of newer anticoagulants over warfarin were driven by a significant reduction in hemorrhagic strokes (reduced to half).
Physicians should be aware of the potential higher mortality with dabigatran over warfarin when treating a bleeding patient.
Overall, these studies have demonstrated a substantially favorable benefit risk profile for apixaban over warfarin and aspirin in NVAF.
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The risk of GI bleeding should be taken under consideration for patients receiving NOACs; however, some patient populations may benefit greatly from the use of NOACs over traditional warfarin therapy.
In patients with cancer, treatment of VTE with a LMWH for 3 6 months has demonstrated better efficacy than and similar safety to treatment with an injectable anticoagulant transitioned over to warfarin for a similar duration.
The development of acute kidney injury (AKI) due to glomerular haemorrhage has been described in patients with IgA nephropathy and warfarin over-anticoagulation [ 1, 2].
Curiously, while ALT was found to contribute significantly to over-anticoagulation during warfarin initiation in a cohort of patients from Asian descent, it was not significant in our INR >4 analysis [ 43].
In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, for the primary endpoint (P = 0.046).
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