But a new randomized double-blind study published yesterday in the New England Journal of Medicine suggests that there's a new sheriff in town : apixiban, a novel oral anticoagulant, was not inferior to traditional vitamin K antagonist, warfarin, over 6 months in preventing pulmonary embolism from deep venous thrombosis. In fact, without having to worry about vitamin K dietary habits or regular testing, apixiban had similar outcomes to dose-adjusted warfarin. More importantly, there was no increase in bleeding events (something that was of concern in atrial fibrillation studies comparing NOACs to warfarin).
As the editorialist noted , NOACs have not truly & readily replaced warfarin in all patients for all indications. More importantly, there's also the cost factor to consider. However, in certain circumstances, it may be time to consider the new sheriff when it comes to preventing pulmonary embolism. As always, talk this over w/your patient or physician, whichever the case may be.
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