Novel oral anticoagulants’ efficacy and safety in comparison to vitamin K antagonists and low molecular weight heparins

Abstract

Aim: The last standard treatment for venous thromboembolism (VTE) is oral anticoagulation with a vitamin K antagonist. Treatment with a vitamin K antagonist requires frequent monitoring of the international normalized ratio (INR), and these drugs have several disadvantages. Direct oral anticoagulants are alternative drugs to oral anti-vitamin K anticoagulants. With safer ranges, novel oral anticoagulants (NOACs) have been accepted in guidelines as drugs of choice. This study aimed to retrospectively examine the outcomes of three new-generation anticoagulant drugs in a patient group. Methods: Two hundred eighteen adults were included in this retrospective cohort study. Patients are included in this study if they had been used any of these drugs in the past: Warfarin, low molecular weight heparin (LMWH), dabigatran, apixaban, and rivaroxaban. The study was conducted retrospectively for evaluating safety and effectiveness. Treatment charges for LMWH, warfarin, and NOAC were calculated based on info from the medical monitoring fee, approximate hospital transportation costs per INR measurement, and drug fees for 6 months. Results: In comparison with warfarin (n: 1, 1.4%), the risk of embolism recurrence was found higher with apixaban (n: 6, 20%, RR: 14.4, OR: 17.75, 95% CI: 2.03-154.99, p=0.002) and rivaroxaban (n: 6, 19.4%, RR: 13.94, OR: 17.04, 95% CI: 1.95-148.57, p=0.003) in patient groups. Conclusion: Compared to the literature, the rivaroxaban and apixaban groups had greater bleeding and recurrence risk in our study. This may be due to dietary habits and genetic factors.

Keywords

• Factor Xa inhibitors
• dabigatran etexilate
• heparin
• low molecular weight warfarin