Comparative Effectiveness of Warfarin and New Anticoagulants
Authors: James A. Reiffel
Journal: Annals of Internal Medicine (2013)

Letters16 April 2013Comparative Effectiveness of Warfarin and New AnticoagulantsJames A. Reiffel, MDJames A. Reiffel, MDFrom Columbia University Medical Center, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-8-201304160-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Although informative, Adam and colleagues' review (1) contained important biases against NOACs that readers should recognize. The review did not compare the primary end points of the trials—the combination of all strokes and systemic embolisms. The authors compared only specific secondary analyses. For the primary end points, dabigatran and apixaban were superior to warfarin (rivaroxaban was noninferior). After all, in nonvalvular atrial fibrillation, reduction of embolisms is the primary goal of therapy. The authors also did not note that the updated guidelines by the American College of Chest Physicians (2) list dabigatran as preferable to warfarin, and ...References1. Adam SS, McDuffie JR, Ortel TL, Williams JW. Comparative effectiveness of warfarin and new oral anticoagulants for the management of atrial fibrillation and venous thromboembolism: a systematic review. Ann Intern Med. 2012;157:796-807. [PMID: 22928173] LinkGoogle Scholar2. You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, et al; American College of Chest Physicians. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:531S-75S. [PMID: 22315271] CrossrefMedlineGoogle Scholar3. Furie KL, Goldstein LB, Albers GW, Khatri P, Neyens R, Turakhia MP, et al; American Heart Association Stroke Council. Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: a science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:3442-53. [PMID: 22858728] CrossrefMedlineGoogle Scholar4. U. S. Food and Drug Administration. FDA Drug Safety Communication: Update on the Risk for Serious Bleeding Events with the Anticoagulant Pradaxa (Dabigatran). Accessed at www.fda.gov/Drugs/DrugSafety/ucm326580.htm on 8 March 2013. Google Scholar5. Hohnloser SH, Oldgren J, Yang S, Wallentin L, Ezekowitz M, Reilly P, et al. Myocardial ischemic events in patients with atrial fibrillation treated with dabigatran or warfarin in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial. Circulation. 2012;125:669-76. [PMID: 22215856] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Columbia University Medical Center, New York, New York.Disclosures: Consultancy: Boehringer-Ingelheim, Janssen; Grants/grants pending: Boehringer Ingelheim, RE-LY trial; Grants/grants pending (money to institution): Boehringer Ingelheim, RE-LY trial; Payment for lectures including service on speakers bureaus: Boehringer Ingelheim, Janssen, Pfizer, Bristol-Myers Squibb; Payment for development of educational presentations: Boehringer Ingelheim, Janssen, Sanofi. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Effectiveness of Warfarin and New Oral Anticoagulants for the Management of Atrial Fibrillation and Venous Thromboembolism Soheir S. Adam , Jennifer R. McDuffie , Thomas L. Ortel , and John W. Williams Jr. Comparative Effectiveness of Warfarin and New Anticoagulants Soheir S. Adam , Thomas L. Ortel , and John W. Williams Jr. Comparative Effectiveness of Warfarin and New Anticoagulants Robert L. Trowbridge and Kathryn E. Smith Metrics 16 April 2013Volume 158, Issue 8Page: 637KeywordsAtrial fibrillationHemorrhageInfarctionMyocardial infarctionPopulation statisticsRisk managementStrokeThoraxThrombin ePublished: 16 April 2013 Issue Published: 16 April 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...