The Controversy Continues Again: which Direct Anticoagulant is More Effective and Safe when Administered to Patients with Atrial Fibrillation?

S Yu Martsevich

doi:10.20996/1819-6446-2020-08-09

Abstract

The data from the observational study of M. Fralick et al. were analyzed in the article. The authors analyzed a large database of patients with atrial fibrillation and concluded that rivaroxaban is inferior to apixaban in its ability to prevent ischemic stroke and systemic embolism and is more likely to cause bleeding. Serious methodological defects of the analysis take place. No statistical methods are capable of correcting the absence of such important information in the database as the doctor's motives for prescribing a particular drug, as well as the patient's adherence to taking it. It is also noted that the patients included in the study, according to clinical characteristics, did not correspond to the typical population of patients with atrial fibrillation. The author considers the conclusions made in the mentioned work to be unauthorized.

Highlights

В статье рассматриваются данные наблюдательного исследования M
The authors analyzed a large database of patients with atrial fibrillation and concluded that rivaroxaban is inferior to apixaban in its ability to prevent ischemic stroke and systemic embolism and is more likely to cause bleeding
No statistical methods are capable of correcting the absence of such important information in the database as the doctor's motives for prescribing a particular drug, as well as the patient's adherence to taking it

Summary

Сергей Юрьевич Марцевич*

Национальный медицинский научно-исследовательский центр терапии и профилактической медицины Россия, 101990, Москва, Петроверигский пер., 10. The Controversy Continues Again: which Direct Anticoagulant is More Effective and Safe when Administered to Patients with Atrial Fibrillation? The authors analyzed a large database of patients with atrial fibrillation and concluded that rivaroxaban is inferior to apixaban in its ability to prevent ischemic stroke and systemic embolism and is more likely to cause bleeding. For citation: Martsevich S.Y. The Controversy Continues Again: which Direct Anticoagulant is More Effective and Safe when Administered to Patients with Atrial Fibrillation? В целом ряде статей, опубликованных в журнале Рациональная Фармакотерапия в Кардиологии [1,2], мы неоднократно поднимали проблему выбора препарата практическим врачом, способов доказательств адекватности такого выбора, в частности, роли различных видов исследований в иерархии этих доказательств. Наличие нескольких близких по Received/Поступила: 06.07.2020 Accepted/Принята в печать: 09.07.2020 действию препаратов всегда создает сложности в выборе конкретного препарата для врача и дает повод для не всегда добросовестной конкуренции фармацевтических компаний, эти препараты производящих

Проблема выявления наиболее эффективного и безопасного ПОАК

Частота инсультов