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SUMMARY
This Figure summarizes the class effects and the differentiators of these new classes of anticoagulation agents. All 3 NOACs are at least noninferior to warfarin in terms of reducing the risk of stroke and systemic embolism (and warfarin is already an adequate therapy for this outcome). All 3 reduce the risk of bleeding and intracerebral hemorrhage -- and the direction and magnitude of mortality reduction for all 3 is consistently about 10% per year.[96][99] Among the 3, the higher 150 mg bid dose of dabigatran is associated with a reduction in ischemic stroke.[96] Rivaroxaban confers its benefit with once a day dosing. Apixaban requires twice daily dosing, but it is associated with a statically significant decrease in all-cause, but not cardiovascular, mortality.[99]
Reiffel JA. Am J Med 2013; 126: 00-00.
[96] Connolly SJ, Ezekowitz MD, Yusuf S, et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-1151.
[99] Granger CB, Alexander JH, McMurray JV, et al; the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.