Evidence map›Paper›PMID 29973392›Full record

ArticleBMJ (Clinical research ed.)2018

Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care.

Yana Vinogradova, Carol Coupland, Trevor Hill, Julia Hippisley-Cox

Erratum issued Registry-linked trialOpen access · hybridAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07290608 (Clinical Performance of the DOACT Algorithm Versus AI-Based Decision Models in Oral Anticoagulant Therapy for Vascular Patients), which is not on this map. Cited by 151 papers, 22 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
151citing papers in PubMed, 22 pooled it
25.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07290608 nacompletednot on this mapstarted 2025, after this paper: background citation

Clinical Performance of the DOACT Algorithm Versus AI-Based Decision Models in Oral Anticoagulant Therapy for Vascular Patients

TypeinterventionalSponsorITALO EUGENIO SOUZA GADELHA DE ABREURan2025 to 2025Enrolled59ConditionsDeep Vein Thrombosis, Superficial Thrombophlebitis, Pulmonary Thromboembolisms, Clinical Decision Support SystemsArmsDOACT algorithm, No algorithm, LLM-based tools
3 · Its place in the literature

Who cites it

151 citing papers in PubMed, 22 syntheses or guidelines pooled it, 268 citations in OpenAlex.

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91 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Yana VinogradovaDivision of Primary Care, 13th floor, Tower Building, University Park, University of Nottingham, Nottingham NG2 7RD, UK Yana.Vinogradova@nottingham.ac.uk.
Carol CouplandDivision of Primary Care, 13th floor, Tower Building, University Park, University of Nottingham, Nottingham NG2 7RD, UK.
Trevor HillDivision of Primary Care, 13th floor, Tower Building, University Park, University of Nottingham, Nottingham NG2 7RD, UK.
Julia Hippisley-CoxDivision of Primary Care, 13th floor, Tower Building, University Park, University of Nottingham, Nottingham NG2 7RD, UK.
University of Nottingham · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate the associations between direct oral anticoagulants (DOACs) and risks of bleeding, ischaemic stroke, venous thromboembolism, and all cause mortality compared with warfarin.

designProspective open cohort study.

settingUK general practices contributing to QResearch or Clinical Practice Research Datalink.

participants132 231 warfarin, 7744 dabigatran, 37 863 rivaroxaban, and 18 223 apixaban users without anticoagulant prescriptions for 12 months before study entry, subgrouped into 103 270 patients with atrial fibrillation and 92 791 without atrial fibrillation between 2011 and 2016.

main outcome measuresMajor bleeding leading to hospital admission or death. Specific sites of bleeding and all cause mortality were also studied.

resultsIn patients with atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (adjusted hazard ratio 0.66, 95% confidence interval 0.54 to 0.79) and intracranial bleeding (0.40, 0.25 to 0.64); dabigatran was associated with a decreased risk of intracranial bleeding (0.45, 0.26 to 0.77). An increased risk of all cause mortality was observed in patients taking rivaroxaban (1.19, 1.09 to 1.29) or on lower doses of apixaban (1.27, 1.12 to 1.45). In patients without atrial fibrillation, compared with warfarin, apixaban was associated with a decreased risk of major bleeding (0.60, 0.46 to 0.79), any gastrointestinal bleeding (0.55, 0.37 to 0.83), and upper gastrointestinal bleeding (0.55, 0.36 to 0.83); rivaroxaban was associated with a decreased risk of intracranial bleeding (0.54, 0.35 to 0.82). Increased risk of all cause mortality was observed in patients taking rivaroxaban (1.51, 1.38 to 1.66) and those on lower doses of apixaban (1.34, 1.13 to 1.58).

conclusionsOverall, apixaban was found to be the safest drug, with reduced risks of major, intracranial, and gastrointestinal bleeding compared with warfarin. Rivaroxaban and low dose apixaban were, however, associated with increased risks of all cause mortality compared with warfarin.

Indexed as

Administration, OralAgedAnticoagulantsAtrial FibrillationComorbidityDabigatranDose-Response Relationship, DrugFemaleFollow-Up StudiesHemorrhageHumansIncidenceMalePatient SafetyPrimary Health CareProspective StudiesAnticoagulantsapixabanDabigatranPyrazolesPyridonesRivaroxabanWarfarin

Identifiers

PMID29973392
PMCPMC6031213
OpenAlexW2810340659

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.