New Oral Anticoagulants: Ready for Prime Time?

Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at

Far be it for me to question the Food & Drug Administration regarding their decision over a year ago to approve two new oral anticoagulants for use in preventing stroke in atrial fibrillation, but as I noted last week, a study was just published in the Archives of Internal Medicine concluding that these new oral anticoagulants increased risk of bleeding in patients prescribed anti-platelet agents in response to an acute coronary syndrome. 

As you know, life isn't always that simple & clear cut, as a study was published last week in the British Medical Journal in which the authors concluded that these very same new oral anticoagulants did not increase risk of bleeding compared to traditional vitamin K antagonist while demonstrating similar event reduction & all-cause mortality when used to treat acute venous thromboembolism.

Why the difference? This time, the authors analyzed data from nine studies comprised of 16,701 participants regarding effectiveness and 16,611 regarding safety when used for treatment of acute venous thromboembolism and prevention of same. In fact, use of rivaroxaban was associated with lower risk of bleeding. 

Bottom line: assuming one survives the wallet biopsy, these new oral anticoagulants are safe for use in treating DVT, but not in preventing same in the immediate post-ACS period of time while taking an anti-platelet agent, too. Ah, the devil is in the details.