The best blood thinners to reduce the risk of bleeding

A new study led by researchers at University College London made a large-scale comparison of direct oral anticoagulants (blood thinners) and found that the drug had the lowest
risk of causing bleeding.
Oral anticoagulants are often used to treat irregular heartbeats
.

In a paper published in the Annals of Internal Medicine, the researchers report that apixaban, one of the two most common direct-to-mouth anticoagulants (DOACs), has the lowest risk of gastrointestinal bleeding and similar
efficacy in preventing stroke and other side effects.

DOAC is used to prevent stroke in people with atrial fibrillation (slow or irregular heartbeat), a disease that affects more than 33 million people
worldwide.
They have recently become more common than warfarin, the previous standard treatment, because they do not require as much follow-up monitoring (which is especially valuable during the Covid-19 pandemic) and have a lower
risk of side effects.

In the new study, researchers compared the efficacy and risk
of side effects of the four most common types of DOACs.
They reviewed data from more than 500,000 new DOAC users in the UK, France, Germany and the US, including 281,320 apixaban users, 61,008 Dabiga users, 12,722 Edoshaban users and 172176 name and devavaruban users
.

They found that the results of the four drugs were comparable for ischemic stroke, cerebral hemorrhage and all-cause mortality, while they also identified differences in the risk of gastrointestinal bleeding, one of
the most common and worrisome side effects of DOACs.

Studies have shown that apixaban has a significantly lower risk of gastrointestinal bleeding, with a 19-28%
reduction in risk compared to the other three DOACs.

The researchers found that their findings only apply to data from patients over 80 and chronic kidney disease, two groups that tend to be underrepresented
in clinical trials.

Co-first author Dr Wallis Lau (UCL School of Pharmacy) said: "Direct oral anticoagulants have been prescribed more frequently worldwide in recent years, but evidence for direct comparison of them is limited
.
Our findings suggest that apixaban may be preferable to other blood thinners because it has a lower rate of gastrointestinal bleeding and a similar incidence of stroke, and we hope this finding will be supported
by randomised controlled trials.

"As with all drugs, the potential risks and benefits vary from person to person, so it is still necessary
for each patient to consider all the outcomes and side effects.
"