IHHN Researchers Publish Letter in the New England Journal of Medicine

Researchers from Indus Hospital & Health Network have published a Letter to the Editor in the New England Journal of Medicine (NEJM), offering an important perspective on the interpretation of findings from the COBRRA trial comparing the anticoagulants apixaban and rivaroxaban.

In their correspondence, the authors Dr. Nawal Adnan, Dr. Khawaja Uzair and Dr. Muhammad Junaid Patel highlighted as a potential confounding factor in the trial’s reported lower bleeding risk with apixaban. They note that because complete adherence was lower among participants receiving apixaban, missed doses may have reduced overall drug exposure, potentially contributing to fewer bleeding events.

The letter emphasizes that, in the absence of a per-protocol analysis or data directly linking missed doses to clinical outcomes, it remains uncertain whether the observed safety advantage of apixaban reflects its intrinsic pharmacologic properties or differences in patients’ medication-taking behavior.

The publication underscores the importance of considering treatment adherence when interpreting clinical trial results and contributes to the ongoing scientific discussion on the comparative safety of direct oral anticoagulants.