New warfarin study

2018 Oct 25

" In patients with atrial fibrillation, self-managed oral anticoagulant treatment was associated with a significantly lower risk of all-cause and ischaemic stroke compared to treatment with DOAC, whereas no significant differences were observed for major bleeding and mortality."

[www.ncbi.nlm.nih.gov]

Interesting, but considering that their results differ dramatically from numerous previous studies, I'm extremely skeptical that warfarin is superior to DOACs as these results seem to suggest. There are a lot of obvious potential confounders and selection biases here, which they tried to account for, but who's to say they succeeded? Offhand, my guess would be that the PSM group tended to be much more compliant. They acknowledge that in the full text of the study:

Quote

Furthermore, the rigorous monitoring of PSM patients likely results in improved adherence compared to patients receiving usual care with VKA or DOAC.

I think what this study likely shows is that patient self monitoring is highly effective, which isn't surprising, really. Patients who can and will self monitor tend to be people who pay attention to their health and don't miss their meds.

Quote
Carey
Interesting, but considering that their results differ dramatically from numerous previous studies

The important factor appears to better methods of staying within the INR range.

"In our study, the risk of intracranial bleeding was low in both groups, but numerically lower in the PSM group
and the low risk of intracranial bleeding in PSM patients is at least partly explained by the high quality of anticoagulant control with INR values within the target range in >70% of patients14."


Interesting that the warfarin group was a bit sicker:

"The PSM population included 20.4% with indication of heart failure, and patients with cancer (all types including any previous cancers) or chronic pulmonary disease accounted for 9.7% and 2.2%, respectively. By design, these patients were excluded in the DOAC cohort.."

"As detailed in Table 1, the CHA2DS2-Vasc score was slightly higher among patients treated with PSM"



Edited 1 time(s). Last edit at 11/01/2018 01:08AM by jpeters.

Look here:
[ethicalnag.org]