Best blood thinner for minimising bleeding risk identified

A large-scale comparison of direct oral anticoagulants (blood thinners), commonly prescribed for irregular heartbeats, has identified the drug with the lowest risk of bleeding, in a new study led by UCL researchers. In the paper published in Annals of Internal Medicine , the researchers report that one of the two most common direct oral anticoagulants (DOACs), apixaban, has the lowest risk of gastrointestinal bleeding, with similar performance on stroke prevention and other side effects. DOACs are used to prevent strokes for people with atrial fibrillation - slow or irregular heartbeats - a condition affecting over 33 million people worldwide. They have recently become more common than warfarin, the previous standard treatment, as they do not require as much follow-up monitoring (which was particularly valuable during the Covid-19 pandemic) and have less risk of side-effects. For the new study, the researchers compared the efficacy and risk of side effects for the four most common DOACs. They reviewed data from more than 500,000 new DOAC users in the UK, France, Germany and the US, including 281,320 apixaban users, 61,008 dabigatran users,12,722 edoxaban users, and 172,176 rivaroxaban users. They found that all four drugs were comparable on outcomes for ischemic stroke, brain bleeds and all-cause mortality, while they did identify a difference in risk of gastrointestinal bleeding, which is one of the most common and concerning side effects of DOACs.