Summary of NOAC Phase III Results

Despite the reluctance of the guidelines to recognize distinctions among the NOACs, the randomized clinical trials have suggested there may be differences among these agents (Figure 20)[28] [29][30] For example,

• dabigatran (high dose, 150 mg)[28] and apixaban [30] have shown superiority compared with warfarin for prevention of stroke and systemic embolism, whereas the other agents in other trials did not.

• there was increased GI bleeding with dabigatran 150 mg[28] and with rivaroxaban,[29] but this was not seen with dabigatran (low-dose, 110 mg)[28] or apixaban.[30]

These apparent differences may provide helpful information, but of course it is not statistically valid to compare results across trials with different patients, different regimens, etc. Camm J. Am J Med 2013; published on-line at http://education.amjmed.com/00000.

References

[28] Connolly SJ, Ezekowitz MD, Yusuf S, et al; Randomized Evaluation of Long-Term Anticoagulation Therapy Investigators. Newly identified events in the RE-LY trial. N Engl J Med. 2010;363:1875-1876.

[29] Patel MR, Mahaffey KW, Garg J, et al; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-891.

[30] Granger CB, Alexander JH, McMurray JJ, et al; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.