New Oral Anticoagulants for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation

Warfarin has been the mainstay of oral anticoagulant therapy for many years. Now, new oral anticoagulants are being used to prevent stroke and other thromboembolic events in patients with atrial fibrillation. This project assessed the newer oral anticoagulants: dabigatran (Pradax), rivaroxaban (Xarelto), and apixaban (Eliquis).

Related projects

• Antithrombotic Therapy for Patients with Atrial Fibrillation: An extension to this project, which will include antiplatelet drugs, such as acetylsalicylic acid (ASA) and clopidogrel.
• Optimal Warfarin Management for the Prevention of Thromboembolic Events in Patients with Atrial Fibrillation: Warfarin is safe and effective in preventing stroke and other complications in patients with atrial fibrillation, but there's still room for improvement in how it's managed.

Tools

Please see the tools created for our more recent project, Antithrombotic Therapy for Patients with Atrial Fibrillation.

Key Messages

CADTH's work on this project resulted in several key messages.

• Warfarin is the recommended first-line therapy for preventing stroke in patients with atrial fibrillation.
  • Warfarin is proven to be a safe, effective, and cost-effective first choice for therapy.
  • Many patients taking warfarin do well on the medication. For these patients, there is no evidence to support switching therapies.
• New oral anticoagulants are a second-line option for some patients with non-valvular atrial fibrillation who are not doing well on warfarin.
  • Although they are as effective at preventing stroke as warfarin, the newer drugs are more expensive and little is known about their long-term safety.
• If a new oral anticoagulant is prescribed, patients must be monitored.
  • Regular assessments of adherence to treatment, kidney function, drug interactions, and bleeding risk are necessary.
  • If bleeding occurs, there is no antidote or proven management strategy.

The Canadian Drug Expert Committee (CDEC) provided expert guidance on this project.

Stakeholder feedback was considered at specific stages of this project.

By reviewing the evidence and developing recommendations, CADTH provides health professionals, policy-makers, and patients with the evidence-based resources they need to make informed decisions.