Oral anticoagulants for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation

Atrial fibrillation is the most common form of cardiac arrhythmia and is often caused by high blood pressure or pre-existing heart disease. It can cause blood clots that clog up the blood vessels and can cause a stroke. Anticoagulants are used to prevent that. There is a more recent anticoagulant substance group that blocks certain blood-clotting factors directly. These more recent substances are called direct oral anticoagulants (DOAC). This HTA report examines the effectiveness of DOAC relative to conventional anticoagulants, such as vitamin K antagonists (VKA), taking account of the cost-benefit ratio as well as legal, social, ethical and organisational considerations.

Literary research and a comparison of different clinical studies show that DOAC come out slightly better as regards overall mortality than the conventional indirect medicines (VKA). There were improvements in prevention of bleeding, while the difference between the substance groups for strokes is only minor. The cost-benefit ratio for the DOAC was positive: the use of the more recent substance group (DOAC) is more expensive, but at the same time it renders follow-up examinations superfluous. No legal, organisational, social or ethical issues were noted.

The HTA report concludes that the use of DOAC mainly entails cost benefits plus slightly better effectiveness.

Last modification 07.06.2023

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