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New blood thinners prove to be safe and effective option for most

The Bottom Line

  • Older adults with conditions such as atrial fibrillation and venous thromboembolism have a higher chance of developing blood clots, which in turn increases the risk of heart attacks and strokes.  
  • Blood thinners may be prescribed to help keep blood clots from forming.
  • New types of blood thinners appear to be effective and safe for most older adults.  

The phrase “new and improved” has been used so often it rarely excites us. Now, instead of rushing out to buy that “amazing” product, we’re more inclined to wait and see if the advertising claims really do hold up. That’s also a wise attitude to adopt when it comes to new drugs and medical procedures. Even though they’ve undergone extensive testing before being approved, there could be side effects or adverse reactions that only surface after they’ve been in use for some time and that call for further investigation. A good example of this is the new oral anticoagulants, belonging to the blood thinners’ family.


Blood thinners are usually given to people at risk of developing blood clots due to conditions such as atrial fibrillation (a common type of irregular heart beat potentially complicated by stroke (2)) and venous thromboembolism (clots which form in the vein, then break loose and travel to the lungs (1)). Older adults are especially at risk of clots and complications from clots (3). For many years, the unique oral blood thinning medicine on the market has been warfarin, which requires extremely careful monitoring and regular dose adjustments by doctors (4).


Enter the new pills on the block: dabigatran, rivaroxaban and apixaban (trade names Pradaxa®, Xarelto® and Eliquis® respectively). They are good at preventing blood clots, require less monitoring, and are simpler for people to take (e.g. just one or two pills daily). However concerns have arisen about the pills causing excessive bleeding in older adults (5;6).


Several research studies were conducted to test the new blood thinners, including 10 randomized controlled trials that formed the basis of a recent systematic review. The purpose of the review was to find out if the pills helped prevent heart attacks and strokes and if they caused side effects such as bleeding (7). The participants – more than 25,000 men and women aged 75 or older – were put on blood thinners because they had venous thromboembolism, pulmonary embolism, atrial fibrillation or were critically ill.


What the research tells us

The studies showed that the new blood thinners did not cause serious bleeding and were at least as effective, if not more so, than the usual treatment in preventing heart attacks, strokes or deaths from cardiac disease in elderly adults.


Another 2014 systematic review, this one involving 45 randomized controlled trials and close to 45,000 participants with acute venous thromboembolism, produced similar findings (8). Several treatments and treatment combinations were compared and while all of the newer options prevented clots at least as well as – if not better than – traditional drugs, rivaroxaban and apixaban caused less serious bleeding.


Even more reassuring for people prescribed these blood thinners: a new antidote has been proven to quickly reverse the effects of these medications and stop bleeding within minutes in an emergency (9).


While it would appear that in these cases the pills are indeed both new and improved, the authors of the reviews caution against a “one drug fits all” approach. People should talk to their doctors about any special concerns, including their risk for bleeding, to ensure they’re prescribed the appropriate medication.

Updated Oct 15/2015

Are you worried about taking multiple medications and drug interactions? Click here to read our blog posts on polypharmacy.


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References

  1. Camm AJ, Lip GYH, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. [internet] European Society of Cardiology; 2012. [cited 2015 Mar 17] Available from: http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/atrial-fibrillation.aspx  
  2. Becker RC. Heart attack and stroke prevention in women. Circulation. 2005; 112:e273-e275. 
  3. Deedwania PC. New oral anticoagulants in elderly populations with atrial fibrillation. AM J Med. 2013; 126:289-296. 
  4. Zarraga IG, Kron J. Oral anticoagulation in elderly adults with atrial fibrillation: Integrating new options with old concepts. J Am Geriatr Soc. 2013; 51:143-150. 
  5. Harper P, Young I, Merriman E. Bleeding risk with dabigatran in elderly patients. N Engl J Med. 2012; 366:864-866. 
  6. Wychowski, MK, Kouides PA. Dabigatran-induced gastrointestinal bleeding in an elderly patient with moderate renal impairment. Ann Pharmacother. 2012; 46:e10. 
  7. Sardar, P Chatterjee S, Chaudhari S et al. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc. 2014; 62:857-64
  8. Castellucci LA, Cameron C, Le Gal G et al. Clinical and safety outcomes associated with treatment of acute venous thromboembolism: a systematic review and meta-analysis. JAMA. 2014; 312:1122-1135.
  9. Siegal DM, Curnutte JT, Connolly SJ et al.  Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med. 2015; Nov 11: doi 10.1056/NEJMoa1510991.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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