No change is needed in use of direct oral anticoagulants following EMA-funded study
Press release
Human
Medicines
Pharmacovigilance
Referrals
No change to the conditions of use of the direct oral anticoagulants Eliquis (apixaban), Pradaxa (dabigatran etexilate) and Xarelto (rivaroxaban) is needed following a review of the results of a European study of real-world data for these medicines.
The study, commissioned by EMA and using real-world data from Denmark, France, Germany, Spain, the Netherlands and the United Kingdom, assessed the risk of serious bleeding with these 3 medicines when used to prevent blood clotting in patients with non-valvular atrial fibrillation (irregular rapid contractions of the heart) and compared this with other oral anticoagulants called vitamin K antagonists.1,2
The results were reviewed by EMA’s human medicines committee (CHMP), in consultation with EMA’s safety committee (PRAC), and were compared with data from other similar studies and in the published literature.
EMA’s review concluded that the pattern of serious bleeding seen in patients taking Eliquis, Pradaxa and Xarelto was similar to that seen in the clinical trials on which the authorisation of the medicines were based. The data were not sufficient to allow robust conclusions to be drawn on comparisons between the 3 medicines.
The study also looked at whether the use of the medicines in clinical practice was in line with the authorised uses and took into account existing contraindications, warnings and advice on interactions with other medicines. EMA concluded that no changes to the product information were warranted, as the data did not provide robust evidence of a high level of non-adherence to the authorised product information.
The study results provided further data on the known increased risk of bleeding in older patients (>75 years). The companies marketing these direct oral anticoagulant medicines will be asked to further explore the issue and to investigate whether changes to the recommended doses could be beneficial for these patients.
Information for patients
Information for healthcare professionals
More about the medicine
The direct oral anticoagulants Eliquis (apixaban), Pradaxa (dabigatran etexilate) and Xarelto (rivaroxaban) are taken by mouth to prevent blood clotting in a number of situations, including in patients with non-valvular atrial fibrillation. They are also used to treat deep vein thrombosis (a blood clot in a deep vein, usually in the leg) and pulmonary embolism (a clot in a blood vessel supplying the lungs), and to prevent these conditions from reoccurring.
These medicines work by directly blocking a single blood clotting factor in the body; this is why they are called ‘direct anticoagulants’ as opposed to other anticoagulants such as warfarin that indirectly target various clotting factors.
More information about these medicines can be found on the EMA website:
More about the procedure
The review of direct oral anticoagulants was initiated on 31 January 2019 at the request of the EMA Executive Director, under Article 5(3) of Regulation 726/2004.
The review has been carried out by the Committee for Medicinal Products for Human Use (CHMP), responsible for questions concerning medicines for human use, which has adopted the Agency’s opinion.
2Ibáñez, L et al. British Journal of Clinical Pharmacology. Nov 2019 85: 2524. Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross?national drug utilization study. Two further publications in preparation.