A “Real World” Look at Safety and Efficacy of the Direct Oral Anticoagulants for Atrial Fibrillation

In a recent meta-analysis of randomized trials in patients with atrial fibrillation (AF), direct oral anticoagulants (DOACs), compared with warfarin, were associated with significantly fewer strokes and systemic embolism events, intracranial hemorrhages, and deaths from all causes, but with more gastrointestinal bleeding events (NEJM JW Gen Med Feb 1 2014 and Lancet 2014; 383:955). However, evidence from “real world” clinical practice is limited. Danish researchers used nationwide databases to identify a cohort of 62,000 oral anticoagulant–naïve patients with nonvalvular AF who were starting treatment with standard doses of DOACs (dabigatran [Pradaxa], 21%; rivaroxaban [Xarelto], 12%; and apixaban [Eliquis], 10%) or warfarin (57%).

During th…