DOACs Best VKAs in Reducing Heart Attacks

While both direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) may reduce the risk for myocardial infarction (MI) in patients with atrial fibrillation (AFib), DOACs have lower risk differences than VKAs, results of new research show.

To better understand the effects of DOACs vs VKAs on the risk for MI, the researchers analyzed data from 31,739 patients with AFib who were listed in Danish health care registers. Patients were stratified by use of apixaban, dabigatran, rivaroxaban, and VKA.


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Using Cox regression analysis, the researchers found that the standardized 1-year risk of MI for VKA was 1.6%, for apixaban was 1.2%, for dabigatran was 1.2%, and for rivaroxaban was 1.1%.

An additional analysis showed that the DOACs had lower risk differences for MI compared with VKA: apixaban, -0.4%; dabigatran, -0.4%; and rivaroxaban, -0.5%.

“No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA,” the researchers concluded.

—Amanda Balbi


Lee CJY, Gerds TA, Carlson N, et al. Risk of myocardial infarction in anticoagulated patients with atrial fibrillation. 2018;72(1):17-26. doi:10.1016/j.jacc.2018.04.036.



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