Comparative Analysis of Newer Oral Anticoagulants in the Management of Coronary Artery Disease: Safety and Efficacy in an Intensive Care Setting
Abstract
Background: Thrombotic events, bleeding complications, hypersensitivity reactions, and treatment compliance provide valuable insights for improving patients' access to anticoagulation guidelines and advancing patient-centred approaches in the care of individuals with thrombotic disorders. Aim: This study evaluated Warfarin, Apixaban, and Dabigatran for their clinical efficacy, safety, and patient satisfaction in the treatment of long-term anticoagulated patients. Methods: A randomised study design comparing three patient groups was conducted. Mean values and frequencies were reported using descriptive statistics, and significant differences between the groups were determined using inferential statistics, namely ANOVA and Chi-square tests. Results: Warfarin was superior to Apixaban and Dabigatran in terms of bleeding risk but was inferior in patient compliance. It was less preferred due to an increased risk of myocardial infarction, stroke, venous thromboembolism, death, recovery, decompensation, and falls. Improvement in patient coagulation markers was also observed in the laboratory with Apixaban or Dabigatran. This confirmed the safety profile of the Apixaban group, which had the lowest hypersensitivity reactions and dropout rates. Thus, the study confirmed the hypothesis that DOACs are safer and more satisfactory for patients than Warfarin, supporting clinical preference for these newer agents. Conclusion: The results highlight the need for individualised strategies in anticoagulation to achieve optimal outcomes. The findings suggest that Apixaban and Dabigatran may be preferred oral options in long-term anticoagulation settings due to their improved safety, better patient compliance, and more favourable clinical outcomes.
Keywords:
Adverse Drug Reactions (ADRS), Anticoagulants, Apixaban, Coronary Artery Disease (CAD), Clinical Efficacy, Dabigatran, Oral Antioagulants, Patient Satisfaction, Pharmacovigilance Thrombotic Events, Thrombotic Events, Warfarin
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References
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Roberti, R., Iannone, L. F., Palleria, C., Curcio, A., Rossi, M., Sciacqua, A., ... &Citraro, R. (2021). Direct oral anticoagulants: From randomized clinical trials to real-world clinical practice. Frontiers in Pharmacology, 12, 684638. https://doi.org/10.3389/FPHAR.2021.684638
Syaban, M. F. R., Yunita, K. C., Faratisha, I. F. D., Erwan, N. E., Waranugraha, Y., & Rizal, A. (2022). Efficacy and safety of apixaban vs. warfarin in atrial fibrillation patients: Systematical review and meta-analysis. Heart Science Journal, 3(1), 28-36. https://doi.org/10.21776/ub.hsj.2022.003.01.5
Talmor-Barkan, Y., Yacovzada, N. S., Rossman, H., Witberg, G., Kalka, I., Kornowski, R., & Segal, E. (2023). Head-to-head efficacy and safety of rivaroxaban, apixaban, and dabigatran in an observational nationwide targeted trial. European Heart Journal-Cardiovascular Pharmacotherapy, 9(1), 26-37. https://doi.org/10.1093/ehjcvp/pvac063
Weissler, E. H., Mulder, H., Rockhold, F. W., Baumgartner, I., Norgren, L., Blomster, J., ... & Jones, W. S. (2022). Understanding study drug discontinuation through EUCLID. Frontiers in Cardiovascular Medicine, 9, 947645https://doi.org/10.3389/fcvm.2022.947645
Yang, L., Brooks, M. M., Glynn, N. W., Zhang, Y., Saba, S., & Hernandez, I. (2020). Real-world direct comparison of the effectiveness and safety of apixaban, dabigatran, rivaroxaban, and warfarin in Medicare beneficiaries with atrial fibrillation. The American Journal of Cardiology, 126, 29-36. https://doi.org/10.1016/J.AMJCARD.2020.03.034
Baldetti, L., Nardelli, P., Ajello, S., Melisurgo, G., Calabrò, M. G., Pieri, M., &Scandroglio, A. M. (2023). Anti-thrombotic therapy with cangrelor and bivalirudin in venoarterial extracorporeal membrane oxygenation patients undergoing percutaneous coronary intervention: A single-center experience. ASAIO Journal, 69(7), e346-e350. https://doi.org/10.1097/MAT.0000000000001871
Beyer, C., Wildauer, M., Feuchtner, G., Friedrich, G., Hintringer, F., Stühlinger, M., & Plank, F. (2020). Relationship of anticoagulant therapies on coronary plaque progression: A longitudinal CTA analysis. Cardiovascular Imaging, 13(1_Part_1), 169-170. https://doi.org/10.1016/J.JCMG.2019.07.021
Burnett, A., & Ansell, J. (2019). Anticoagulants and Treatment of Venous Thromboembolism. In Concise Guide to Hematology (pp. 163-193). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-97873-4_17
Coscas, G., Coscas, F., &Soubrane, G. (2004). Monitoring the patient after treatment: angiographic aspects of recurrence and indications for retreatment. Journal FrancaisD'ophtalmologie, 27(1), 81-92. https://doi.org/10.1016/S0181-5512(04)96099-8
Couturaud, F., Leroyer, C., &Tromeur, C. (2022). Identification of outcomes in clinical studies of interventions for venous thromboembolism in non‐pregnant adults. Journal of Thrombosis and Haemostasis, 20(10), 2204-2206. https://doi.org/10.1111/jth.15849
De Caterina, R. (2009). The current role of anticoagulants in cardiovascular medicine. Journal of Cardiovascular Medicine, 10(8), 595-604. https://doi.org/10.2459/JCM.0B013E32832E490B
Fulk, G. (2023). Descriptive statistics, an important first step. Journal of Neurologic Physical Therapy, 47(2), 63.https://doi.org/10.1097/npt.0000000000000434
Grimshaw, J., Eccles, M., &Tetroe, J. (2004). Implementing clinical guidelines: current evidence and future implications. Journal of Continuing Education in the Health Professions, 24(S1), S31-S37. https://doi.org/10.1002/CHP.1340240506
Hayat, A., Själander, A., &Wallvik, J. (2023). Direct oral anticoagulants: Patient reported adherence and minor bleedings. Journal of Thrombosis and Thrombolysis, 56(1), 55-64. https://doi.org/10.1007/s11239-023-02797-8
Hink, U., &Voigtländer, T. (2020). Necessity of Antiaggregation and Anticoagulation and Its Prognostic Impact: A Cardiologist’s View. Visceral Medicine, 36(4), 264-273. https://doi.org/10.1159/000509896
Jansson, M., Själander, S., Sjögren, V., Renlund, H., Norrving, B., &Själander, A. (2020). Direct comparisons of effectiveness and safety of treatment with Apixaban, Dabigatran and Rivaroxaban in atrial fibrillation. Thrombosis Research, 185, 135-141. https://doi.org/10.1016/J.THROMRES.2019.11.010
Karnick, C., Modany, A., McGraw, M., Ludwig, J., Marr, D., Hammonds, T., ... & Culley, E. (2022). Comparison of real-world clinical and economic outcomes in patients receiving oral anticoagulants: A retrospective claims analysis. Journal of Managed Care & Specialty Pharmacy, 28(11), 1304-1315. https://doi.org/10.18553/jmcp.2022.28.11.1304
Kholmukhamedov, A., Subbotin, D., Gorin, A., &Ilyassov, R. (2025). Anticoagulation management: Current landscape and future trends. Journal of Clinical Medicine, 14(5), 63.https://doi.org/10.3390/jcm14051647
Köhler, C., Tittl, L., Marten, S., Naue, C., Spindler, M., Stannek, L., ... & Beyer-Westendorf, J. (2022). Effectiveness and safety of edoxaban therapy in daily-care patients with atrial fibrillation. Results from the Dresden Noac Registry. Thrombosis Research, 215, 37-40. https://doi.org/10.1016/j.thromres.2022.05.010
Li, Z., Wang, X., Li, D., & Wen, A. (2022). Real‐World Comparisons of Low‐Dose NOACs versus Standard‐Dose NOACs or Warfarin on Efficacy and Safety in Patients with AF: A Meta‐Analysis. Cardiology Research and Practice, 2022(1), 4713826.https://doi.org/10.1155/2022/4713826
Maddalena, R. (2023). NOAC Therapy According to CHA2DS2-VASc without atrial fibrillation: A systematic review. Cardiology in Review, 10-1097. https://doi.org/10.1097/CRD.0000000000000570
Mahdy, E. W., El-Hamid, A. M. A., Shady, R. M., &Aglan, B. M. (2022). Choosing between enoxaparin and fondaparinux for the prevention of thromboembolism: a meta-analysis of randomized trials. The Egyptian Journal of Critical Care Medicine, 9(1), 22-30. https://doi.org/10.1097/ej9.0000000000000038
Malhotra, K., Ishfaq, M. F., Goyal, N., Katsanos, A. H., Parissis, J., Alexandrov, A. W., ... &Tsivgoulis, G. (2019). Oral anticoagulation in patients with chronic kidney disease: A systematic review and meta-analysis. Neurology, 92(21), e2421-e2431. https://doi.org/10.1212/WNL.0000000000007534
Mitchell, A., Snowball, J., Welsh, T. J., Watson, M. C., & McGrogan, A. (2022). Safety of direct oral anticoagulants (DOACs) vs. warfarin for people aged≥ 75 years with atrial fibrillation: a cohort study. International Journal of Pharmacy Practice, 30(Supplement_1), i18-i19. https://doi.org/10.1093/ijpp/riac021.025
Peh, L. X. Y., Narayanaswamy, S., & Wang, A. (2019). Comment: safety and efficacy of apixaban versus warfarin in patients with advanced chronic kidney disease. Annals of Pharmacotherapy, 53(1), 101-102. https://doi.org/10.1177/1060028018798755
Roberti, R., Iannone, L. F., Palleria, C., Curcio, A., Rossi, M., Sciacqua, A., ... &Citraro, R. (2021). Direct oral anticoagulants: From randomized clinical trials to real-world clinical practice. Frontiers in Pharmacology, 12, 684638. https://doi.org/10.3389/FPHAR.2021.684638
Syaban, M. F. R., Yunita, K. C., Faratisha, I. F. D., Erwan, N. E., Waranugraha, Y., & Rizal, A. (2022). Efficacy and safety of apixaban vs. warfarin in atrial fibrillation patients: Systematical review and meta-analysis. Heart Science Journal, 3(1), 28-36. https://doi.org/10.21776/ub.hsj.2022.003.01.5
Talmor-Barkan, Y., Yacovzada, N. S., Rossman, H., Witberg, G., Kalka, I., Kornowski, R., & Segal, E. (2023). Head-to-head efficacy and safety of rivaroxaban, apixaban, and dabigatran in an observational nationwide targeted trial. European Heart Journal-Cardiovascular Pharmacotherapy, 9(1), 26-37. https://doi.org/10.1093/ehjcvp/pvac063
Weissler, E. H., Mulder, H., Rockhold, F. W., Baumgartner, I., Norgren, L., Blomster, J., ... & Jones, W. S. (2022). Understanding study drug discontinuation through EUCLID. Frontiers in Cardiovascular Medicine, 9, 947645https://doi.org/10.3389/fcvm.2022.947645
Yang, L., Brooks, M. M., Glynn, N. W., Zhang, Y., Saba, S., & Hernandez, I. (2020). Real-world direct comparison of the effectiveness and safety of apixaban, dabigatran, rivaroxaban, and warfarin in Medicare beneficiaries with atrial fibrillation. The American Journal of Cardiology, 126, 29-36. https://doi.org/10.1016/J.AMJCARD.2020.03.034
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Kandukuri, M., & Krishnan, K. (2025). Comparative Analysis of Newer Oral Anticoagulants in the Management of Coronary Artery Disease: Safety and Efficacy in an Intensive Care Setting. International Journal of Advancement in Life Sciences Research, 8(3), 178-195. https://doi.org/https://doi.org/10.31632/ijalsr.2025.v08i03.017
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