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Evidence Summary
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Got It, Hide thisNew anticoagulant pills reduce cardiovascular events and do not increase serious bleeding
Sardar P, Chatterjee S, Chaudhari S, et al. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc. 2014;62:857-64.
Review questions
In people 75 years of age or older who have atrial fibrillation, venous thromboembolism, or who are critically ill, do new anticoagulant pills (blood thinners) prevent cardiovascular events? Do they have side effects, such as serious bleeding?
Background
People with conditions such as atrial fibrillation or venous thromboembolism are at increased risk of developing blood clots, which can increase the risk of heart attacks or stroke. Doctors may prescribe anticoagulant pills to reduce the formation of blood clots. Warfarin (Coumadin®) is the anticoagulant pill prescribed most often. It requires careful monitoring by doctors and can cause serious bleeding. Newer anticoagulant pills are available and may be more effective, safer and easier to take.
How the review was done
The researchers did a systematic review, searching for published studies up to March 2013. They found 10 randomized controlled trials with 25,031 people 75 years of age or older.
People in the trials had venous thromboembolism, pulmonary embolism, or atrial fibrillation, or were critically ill.
New anticoagulant pills included rivaroxaban (Xarelto®), apixaban (Eliquis®), and dabigatran (Pradaxa®).
New anticoagulant pills were compared with usual treatment (warfarin, low-molecular weight heparin, or aspirin) or placebo.
Outcomes were cardiovascular events (venous thromboembolism; death due to venous thromboembolism; or stroke or systemic embolism), and serious bleeding.
What the researchers found
Compared with usual treatment or placebo, new anticoagulant pills:
- reduced venous thromboembolism or death due to venous thromboembolism by about 33 people out of 1000; and
- reduced stroke or systemic embolism by about 15 people out of 1000.
New anticoagulant pills did not differ from usual care or placebo for bleeding events at up to 2 years.
Conclusion
In people over 75 years of age with atrial fibrillation, venous thromboembolism, or critical illness, new anticoagulant pills reduce cardiovascular events without increasing serious bleeding.
New anticoagulant pills vs usual treatment (warfarin, low-molecular weight heparin, or aspirin) or placebo
| Outcomes at about 2 years | Number of trials | New anticoagulant pills | Usual treatment or placebo | Effect of new anticoagulant pills |
| Venous thromboembolism or death due to venous thromboembolism | 6 trials | 3.7% | 7.0% | About 33 fewer people out of 1000 had the outcome |
| Stroke or systemic embolism | 4 trials | 3.2% | 4.7% | About 15 fewer people out of 1000 had the outcome |
| Serious bleeding | 8 trials | 6.4% | 6.3% | No effect* |
Glossary
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
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