POEMs

Real-World Study Finds Lower Mortality and Stroke Risk with Dabigatran, but More GI Bleeds

 


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Am Fam Physician. 2015 Sep 15;92(6):529-530.

Clinical Question

In a real-world setting, how do the harms of dabigatran (Pradaxa) and warfarin (Coumadin) compare?

Bottom Line

In this well-designed observational study, older patients given an initial prescription of dabigatran had lower all-cause mortality (number needed to treat [NNT] = 192 for one year) and fewer ischemic and hemorrhagic strokes, but a higher risk of gastrointestinal (GI) bleeding, than a matched group of patients given warfarin. Benefits and harms were greater at the higher dose (150 mg) and varied by age and sex. Specifically, women 85 years and older had higher all-cause mortality with dabigatran. (Level of Evidence = 2b)

Synopsis

The comparative safety of the novel oral anticoagulants is important knowledge, because they are being widely adopted at great cost to the health system. Although they are clearly more convenient than warfarin, are they also safer? This study identified Medicare

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



 

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