DÄ internationalArchive13/2019Suffers From Conflicts of Interest
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Although Altiok and Marx cite important statements on non-vitamin K antagonist oral anticoagulants (NOACs), such as the non-necessity of bridging shown in the BRIDGE study, contraindications for artificial heart valves, and not switching treatment for patients who react well to vitamin K antagonists (VKA), the article does not give an objective view of the study situation (1).

In particular, in the abstract, the authors uncritically follow the European Society of Cardiology (ESC) recommendations by favoring NOACs over VKA. However, these recommendations suffer from conflicts of interest. The well-founded opinion of the Drug Commission of the German Medical Association, that VKA should be the first-line drug of choice, are not mentioned.

Despite the supposed superiority of NOACs postulated by the authors, German real-world data shows the opposite situation. The data presented on the quality of anticoagulation using VKA of TTR (time in therapeutic range) of 55%–65% do not agree with the German TTR (of more than 70%). In Germany, NOACs offer no advantages over VKA.

DOI: 10.3238/arztebl.2019.0220a

Dr. med. Thomas Maibaum
Facharzt für Allgemeinmedizin
Rostock, Germany
thomas.maibaum@yahoo.de

Dr. med. Günther Egidi
Facharzt für Allgemeinmedizin

Bremen, Germany
guenther.egidi@posteo.de

Conflict of interest statement
Dr. Maibaum has received honoraria from Thieme Medical Publishers.

1.
Altiok E, Marx N: Oral anticoagulation—update on anticoagulation with vitamin K antagonists and non–vitamin K–dependent oral anticoagulants. Dtsch Arztebl Int 2018; 115: 776–83 VOLLTEXT
1.Altiok E, Marx N: Oral anticoagulation—update on anticoagulation with vitamin K antagonists and non–vitamin K–dependent oral anticoagulants. Dtsch Arztebl Int 2018; 115: 776–83 VOLLTEXT

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