What Is the Best Blood Thinner for Minimizing Bleeding Risk?

Various medicinal drugs

Blood thinners that prevent blood from clotting.

In a recent study led by University College London (UCL) researchers, a large-scale comparison of direct oral anticoagulants (blood thinners) commonly recommended for irregular heartbeats revealed the drug with the lowest risk of bleeding.

According to research published in the journal Dr History of Internal MedicineApixaban, one of the two most popular direct oral anticoagulants (DOACs), has the lowest risk of gastrointestinal bleeding and is as effective as other DOACs in preventing stroke and other side effects.

More than 33 million people worldwide suffer from atrial fibrillation, which causes a slow or irregular heartbeat; DOACs are used to prevent stroke in these patients. Compared to warfarin, the former standard of care, they are now more widely used because they require less follow-up monitoring (which was especially helpful during the Covid-19 outbreak) and have a lower risk of side effects.

The new study evaluated the efficacy and risk of adverse effects of the four most commonly used DOACs. They examined data from nearly 500,000 new DOAC users in the UK, France, Germany and the US, including 281,320 apixaban users, 61,008 dabigatran users, 12,722 edoxaban users and 172,176 rivaroxaban users.

They found that all four drugs were comparable in outcomes for ischemic stroke, brain bleeds and all-cause mortality. At the same time, they identified a difference in the risk of gastrointestinal bleeding, one of the most common side effects of DOACs.

The study revealed that apixaban stood out as having a lower risk of gastrointestinal bleeding, with a 19–28% lower risk when compared directly with each of the other three DOACs.

The researchers found that their findings held true only when looking at data from those over 80 and those with chronic kidney disease, two groups that are often underrepresented in clinical trials.

Co-lead author Dr Wallis Lau (UCL School of Pharmacy) said: “Direct oral anticoagulants have been prescribed with increasing frequency worldwide in recent years, but evidence comparing them directly is limited. Our results indicate that apixaban may be preferable to other blood thinners due to lower rates of gastrointestinal bleeding and similar rates of stroke, which we hope will be supported by randomized controlled trials.”

He concludes, “As with all drugs, the potential risks and benefits may differ between people, so it will still be necessary to consider the full spectrum of outcomes and side effects for each patient.”

References: Wallis CY Lau, Ph.D., Carmen Olga Torre, MSc, Kenneth Casey Mann, Ph.D., Henry, Carmen Olga Torre, Comparative Efficacy and Safety of Apixaban, Dabigatran, Edoxaban, and Rivaroxaban in Patients With Atrial Fibrillation, Ph.D., Sarah Seager, BA, Mui Van Zandt, BSc, Christian Reich, MD, Jing Li, MS, Jack Brewster, Ph.D., Gregory YH Lip, MD, Aroon D. Hingorani, Ph.D. , Li Wei, Ph.D. and Ian CK Wong, PhD, November 2022, History of Internal Medicine.
DOI: 10.7326/M22-0511



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