2–6 Although this compares favorably to rates of intracranial hemorrhage secondary to vitamin K antagonist use, it is unclear whether the outcomes of patients experiencing intracranial hemorrhage secondary to DOAC versus vitamin K antagonist use are significantly different. 2–5 However, the risk of ICH remains 0.05% in clinical trials and up to 2% in some real-world data sets. 2–5 Coupled with an overall reduced risk of bleeding, specifically major bleeding and intracranial hemorrhage (ICH), it is clear that the net benefit of DOACs as compared with warfarin in most patients is likely dramatic. 1 In pivotal approval studies for DOACs as anticoagulants in patients with atrial fibrillation, DOACs were consistently identified to be at least noninferior, and in several studies to be superior to warfarin in the prevention of stroke or systemic embolism.
The worldwide utilization of direct acting oral anticoagulants (DOACs) for a number of different indications has continuously increased since their initial approval, with a concomitant reduction in utilization of warfarin.
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