Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.


DOACs safer than warfarin for atrial fibrillation

04 May 2020

In general, direct oral anticoagulants (DOACs) pose less risk of bleeding than do warfarin for the treatment of atrial fibrillation (AF), a new study suggests.

Researchers enrolled 423,450 AF patients, of whom 177,318 were on warfarin, 40,994 were taking rivaroxaban, 32,737 were taking dabigatran and 17,971 were on apixaban. The remaining 154,430 were not taking any such medication. Study outcomes included time to first major bleeding, intracranial haemorrhage (ICH) and major gastrointestinal bleedings (GIBs).

Over a median follow-up of 1.4±0.6 years, 29,459 major bleeding events occurred in 6.9 percent of the participants. Of these, 3,303 were ICH episodes, 11,455 were major GIBs and 22,401 were cases of other major bleedings.

Comparing across all the different types of medication, warfarin showed the highest adjusted rate of any major bleeding, while dabigatran users saw the lowest (6.7 percent vs 4.8 percent per year). The same was true for ICH and GIB, both of which occurred most frequently in the warfarin group and least with dabigatran.

Further risk analysis confirmed that dabigatran users were at a significantly lower risk of major bleeding than their warfarin counterparts (hazard ratio [HR], 0.79, 95 percent confidence interval [CI], 0.75–0.82). Apixaban likewise exhibited a significant protective effect (HR, 0.86, 95 percent CI, 0.80–0.93), while rivaroxaban did not (HR, 0.99, 95 percent CI, 0.95–1.04).

Moreover, rivaroxaban appeared to confer a greater risk of GIB than warfarin (HR, 1.20, 95 percent CI, 1.12–1.27). However, all three DOACs showed superior safety outcomes to warfarin in terms of ICH risk.

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.