Key result
Direct factor Xa inhibitors are superior to warfarin in the prevention of ischemic stroke in patients with non-valvular atrial fibrillation, with a lower rate of major and minor bleeding events.
Why the study?
Appropriate anticoagulants reduce ischemic stroke risk in AF, motivating an analysis of the efficacy, safety, bleeding risks, and food and drug interactions of direct factor Xa inhibitors compared to warfarin.
Do direct factor Xa inhibitors prevent ischemic stroke and reduce bleeding compared to warfarin in patients with non-valvular atrial fibrillation?
Do direct factor Xa inhibitors prevent ischemic stroke and reduce bleeding compared to warfarin in patients with non-valvular atrial fibrillation?
Direct factor Xa inhibitors are superior to warfarin for stroke prevention in non-valvular atrial fibrillation, offering lower bleeding risks and fewer interactions without the need for routine monitoring.
Supports factor Xa inhibitors over warfarin in non-valvular AF; leaves open need for updated prospective trials.
Ischemic stroke remains a major cause of mortality and morbidity in patients with atrial fibrillation. The use of appropriate anticoagulants reduces the risk of ischemic stroke in these patients. The current literature review is aimed to analyze the follow-up efficacy and safety of direct factor Xa inhibitors versus warfarin in the prevention of primary and secondary ischemic stroke, risk of major and minor bleedings, and food and drug interaction in patients with atrial fibrillation (AF). We selected PubMed as our database and we found 83,611 articles using the regular keyword 'atrial fibrillation'. We found 2,224 articles using the regular keywords 'direct factor Xa inhibitors' and 'atrial fibrillation'. Finally, we obtained 326 studies using MeSH keywords: atrial fibrillation, direct factor Xa inhibitors, and warfarin. Ultimately, 46 articles were selected after applying the inclusion/exclusion criteria. All studies were randomized controlled trials (RCT) or clinical trials. Analysis of all studies showed that direct factor Xa inhibitors are superior to warfarin in the prevention of ischemic stroke in patients with non-valvular AF, with a lower rate of major and minor bleeding events and lower foods and drug interaction. Unlike warfarin, direct factor Xa inhibitors do not need frequent blood monitoring and dose adjustment. We found that warfarin and other vitamin K inhibitors may promote the calcification of heart valves and coronary arteries. There is some evidence that direct factor Xa inhibitors may slightly reverse these calcifications in coronary arteries and heart valves.
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Emamy et al. (2020) conducted a review in Non-valvular atrial fibrillation. Direct factor Xa inhibitors vs. Warfarin was evaluated on Prevention of primary and secondary ischemic strokes. Direct factor Xa inhibitors are superior to warfarin in the prevention of ischemic stroke in patients with non-valvular atrial fibrillation, with a lower rate of major and minor bleeding events.
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