Novel anticoagulants of a lies in atrial fibrillation ahead stiftung warentest

Many people with atrial fibrillation are prescribed novel blood thinners. Of these, the active ingredient apixaban appears to be the best.

Four novel anticoagulants approved

Approximately one to two million people in Germany, mainly the elderly, suffer from atrial fibrillation. Although this form of cardiac arrhythmia is not immediately threatening, it does increase the risk of stroke in the long term. Many sufferers are prescribed long-term therapy with blood-thinning medications as a preventive measure. Until a few years ago, these were mostly so-called vitamin K antagonists, namely the active ingredients warfarin or phenprocoumon.

In the meantime, newer anticoagulants are increasingly being used instead: direct oral anticoagulants, or DOACs for short. Four active substances are approved in Germany: Apixaban, dabigatran, edoxaban, and rivaroxaban.

Active ingredient apixaban scores well in large study

Of the four new agents, apixaban appears to be most effective and well tolerated in atrial fibrillation. A new indication for this is provided by a study of researchers from the US-American Vanderbilt University in the scientific journal Jama.

Included data from nearly 600,000 older people with atrial fibrillation who were taking either apixaban or rivaroxaban. The study period was four years, and the evaluation took into account many factors such as concomitant diseases and other medications. This is the first study with a very large data base that directly compares two of the newer active ingredients.

Fewer strokes and bleeding with apixaban

Conclusion of the study: Strokes occurred less frequently in the group receiving apixaban than in the comparison group – and there was also less bleeding, a typically feared side effect. According to the evaluation, 13 to 14 of 1 000 people suffer a serious problem such as stroke or major bleeding each year on apixaban, compared with about 16 of 1 000 on rivaroxaban. Extrapolated to large populations treated with the agents, the difference is very significant. The study confirms indications from previous studies. Supports the ratings in our drug database. There we rate apixaban better than the other representatives of the group: dabigatran, edoxaban and rivaroxaban. These three are only suitable for long-term use, for example in atrial fibrillation, with restrictions.

Apixaban, on the other hand, is "also suitable" in this field of application. As a permanent therapy under everyday conditions, the active ingredient has not yet been tested very much, which is why it does not receive the top rating of "suitable" in our drug evaluation. For tips on the proper use of DOAKs and vitamin K antagonists, see our drug database under anticoagulants.

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Correct intake and concentration are crucial

In contrast to drugs that belong to the group of vitamin K antagonists, the blood clotting of the newer drugs does not have to be checked regularly by measurements. Nevertheless, even with these agents it is enormously important that their concentration in the blood is in the right range. If it is too high, the risk of bleeding increases. If it is too low, vascular occlusions such as strokes are imminent. Take the agents regularly. Exactly as prescribed one. Make sure that your doctor takes into account whether you are taking other medications and how your kidney function is when choosing and dosing your medication. If it is restricted, DOAC may be excreted more poorly, which increases their concentration in the blood and thus the risk of bleeding. Kidney function can deteriorate with age. Therefore, it should also be monitored regularly during the course of treatment.

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