Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.
Research article published in Thrombosis and haemostasis (2012)
Abstract
The concept of net clinical benefit has been used to quantify the balance between risk of ischaemic stroke (IS) and risk of intracranial haemorrhage (ICH) with the use oral anticoagulant therapy (OAC) in the setting of non-valvular atrial fibrillation (AF), and has shown that patients at highest risk of stroke and thromboembolism gain the greatest benefit from OAC with warfarin. There are no data for the new OACs, that is, dabigatran, rivaroxaban and apixaban, as yet. We calculated the net clinical benefit balancing IS against ICH using data from the Danish National Patient Registry on patients with non-valvular AF between 1997-2008, for dabigatran, rivaroxaban and apixaban on the basis of recent clinical trial outcome data for these new OACs. In patients with CHADS(2)=0 but at high bleeding risk, apixaban and dabigatran 110 mg bid had a positive net clinical benefit. At CHA(2)DS(2)-VASc=1, apixaban and both doses of dabigatran (110 mg and 150 mg bid) had a positive net clinical benefit. In patients with CHADS(2) score≥1 or CHA(2)DS(2)-VASc≥2, the three new OACs (dabigatran, rivaroxaban and apixaban) appear superior to warfarin for net clinical benefit, regardless of risk of bleeding. When risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit than warfarin. In the absence of head-to-head trials for these new OACs, our analysis may help inform decision making processes when all these new OACs become available to clinicians for stroke prevention in AF. Using 'real world' data, our modelling analysis has shown that when the risk of bleeding and stroke are both high, all three new drugs appear to have a greater net clinical benefit compared to warfarin.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.
Por qué esto importa para la hirudoterapia
Utilizando los datos del Registro Nacional de Pacientes Danés sobre fibrilación auricular no valvular (1997-2008) combinados con estimaciones de resultados de ensayos clínicos, este análisis de modelización equilibró el accidente cerebrovascular isquémico frente a la hemorragia intracraneal y encontró que para los pacientes con CHADS2 >=1 o CHA2DS2-VASc >=2, los anticoagulantes orales más nuevos (dabigatran, rivaroxaban, apixaban) parecían superiores a warfarin en cuanto al beneficio clínico neto independientemente del riesgo de sangrado, con apixaban y dabigatran mostrando un beneficio neto positivo incluso en subgrupos de menor riesgo y alto riesgo de sangrado. Es relevante para la hirudoterapia como contexto del equilibrio central del campo de la anticoagulación entre prevenir coágulos y causar sangrado, el mismo equilibrio que enmarca cualquier uso clínico del secretoma anticoagulante de la sanguijuela. Advertencia: se trata de un análisis de modelización/cohorte derivado de un registro, no de un ensayo comparativo directo ni de un estudio sobre hirudoterapia; los autores señalan la ausencia de ensayos comparativos directos y que sus conclusiones se basan en una simulación.
Citación
Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study.
Banerjee et al. · Thrombosis and haemostasis, 2012
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026