Интересное наблюдение от шведов - нет разницы в исходах, если пациенты с ФП на варфарине в более 70% пребывают в терапевтическом диапазоне или же получают новые антикоагулянты, но частота кровотечений существенно ниже на апиксабане и дабигатране, но не на ривароксабане (апиксабан получали наибольшее количество пациентов, несмотря на то, что этот препарат пришел на рынок самым последним):
Nationwide retrospective cohort study based on Swedish quality registries. Atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban or warfarin between 2013-01-01 and 2015-12-31 were included. Main outcome measures were all-cause stroke and systemic embolism, all-cause stroke, ischemic stroke, hemorrhagic stroke; major bleeding, intracranial bleeding, gastrointestinal bleeding, other bleeding (fatal or requiring hospital care); all-cause mortality; myocardial infarction.
The study included 64,382 patients corresponding to 81,176 treatment years. Of these, 37,174 patients were instituted on warfarin, 6574 on dabigatran, 8323 on rivaroxaban and 12,311 on apixaban. In warfarin treated patients, the time in therapeutic range was 71.4%. After propensity score matching, there was no significant difference in risk of stroke or systemic embolism between NOAC and warfarin treated patients. Hazard ratios for major bleeding events were 0.63(95%CI 0.52-0.75) for apixaban, 0.74(0.62-0.87) for dabigatran and 1.06(0.92-1.23) for rivaroxaban, compared with warfarin.
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Thromb Res. 2018 May 17;167:113-118.
Dabigatran, rivaroxaban and apixaban vs. high TTR warfarin in atrial fibrillation.
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