Key result
Non-vitamin K antagonist oral anticoagulants reduced stroke or systemic embolism by 19% (HR 0.81, 95% CI 0.73-0.91) and major bleeding (HR 0.80, 95% CI 0.65-0.98) compared with warfarin in pooled trial analyses.
Why the study?
Do non-vitamin K antagonist oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) reduce stroke or systemic embolism and major bleeding compared with warfarin in patients with nonvalvular atrial fibrillation?
Do non-vitamin K antagonist oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) reduce stroke or systemic embolism and major bleeding compared with warfarin in patients with nonvalvular atrial fibrillation?
Answers are grounded in this paper and cite their sources.
This narrative review summarizes the evidence establishing NOACs as noninferior or superior to warfarin for stroke prevention in nonvalvular atrial fibrillation with lower rates of major and intracranial bleeding, while detailing clinical selection criteria across renal function, valvular disease, and concomitant antiplatelet therapy.
Atrial fibrillation (AF) increases a patient's stroke risk four- to five-fold. Anticoagulation with the vitamin K antagonist (VKA) warfarin reduces the risk of stroke by 67%, but warfarin carries a significant risk of major bleeding and has unpredictable pharmacodynamics with a narrow therapeutic window, necessitating frequent monitoring of its anticoagulant effect. The non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban provide more predictable anticoagulant activity than warfarin with a lower risk of major bleeding, and each is noninferior to warfarin for the prevention of stroke. All have earned regulatory approval in the past eight years. At least one of the NOACs is approved for use in all patients with AF, except those with mechanical valves and rheumatic mitral valve disease, for whom warfarin remains the only option. Recent clinical trials have shown that antithrombotic regimens including NOACs are safe and effective in patients with AF who need potent antiplatelet therapy.
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Fanaroff et al. (2018) conducted a review in Atrial fibrillation. Non-vitamin K antagonist oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) vs. Dose-adjusted warfarin (target INR 2.0-3.0) was evaluated on Stroke or systemic embolism (HR 0.81, 95% CI 0.73-0.91). Non-vitamin K antagonist oral anticoagulants reduced stroke or systemic embolism by 19% (HR 0.81, 95% CI 0.73-0.91) and major bleeding (HR 0.80, 95% CI 0.65-0.98) compared with warfarin in pooled trial analyses.
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