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In a meta-analysis of randomized controlled trials also published earlier this month in the Archives of Internal Medicine , the authors concluded that use of anti-Xa or direct thrombin inhibitors is associated with an increase risk of bleeding after an acute coronary syndrome. They reached their conclusion by reviewing 7 prospective RCTs involving 31,286 participants followed for at least 26 weeks on average, up to 124 weeks (or over 2 years).
Of course this is in direct contrast to the fanfare at last year's American Heart Association meeting when rivaroxaban was demonstrated to improve ACS outcomes . How quickly 12 month's turns us on our head. In the meantime, we need to have a thorough conversation with our patients about the pros & cons of their options, including the risk of bleeding events from vitamin K antagonists, Factor Xa inhibitors & direct thrombin inhibitors.
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