James A. Reiffel, MD
Potential Conflicts of Interest: Consultancy: Boehringer-Ingelheim, Janssen; Grants/grants pending: Boehringer Ingelheim, RE-LY trial; Grants/grants pending (money to institution): Boehringer Ingelheim, RE-LY trial; Payment for lectures including service on speakers bureaus: Boehringer Ingelheim, Janssen, Pfizer, Bristol-Myers Squibb; Payment for development of educational presentations: Boehringer Ingelheim, Janssen, Sanofi.
Reiffel JA. Comparative Effectiveness of Warfarin and New Anticoagulants. Ann Intern Med. 2013;158:637. doi: 10.7326/0003-4819-158-8-201304160-00016
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Published: Ann Intern Med. 2013;158(8):637.
TO THE EDITOR:
Although informative, Adam and colleagues' review (1) contained important biases against NOACs that readers should recognize. The review did not compare the primary end points of the trials—the combination of all strokes and systemic embolisms. The authors compared only specific secondary analyses. For the primary end points, dabigatran and apixaban were superior to warfarin (rivaroxaban was noninferior). After all, in nonvalvular atrial fibrillation, reduction of embolisms is the primary goal of therapy. The authors also did not note that the updated guidelines by the American College of Chest Physicians (2) list dabigatran as preferable to warfarin, and a recent stroke consensus document (3) lists all NOACs as such.
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