- For thromboembolism prevention in patients with nonvalvular Afib, direct-acting oral anticoagulants (DOACs) are at least as safe, effective as warfarin (Coumadin).
Why this matters
- Previous meta-analyses did not address subgroups or include intra-DOAC observational data.
- Warfarin vs dabigatran (Pradaxa; thrombin inhibitor):
- RE-LY: Dabigatran outperforms warfarin for preventing stroke or systemic embolism (SSE); similar major bleeding, myocardial infarction, all-cause mortality (ACM) risks;
- 35 observational studies: reduced stroke, SSE, hemorrhagic stroke.
- Warfarin vs factor Xa inhibitors:
- Factor Xa inhibitors performed similarly in multiple subgroups.
- Left atrial appendage closure (PROTECT AF, PREVAIL):
- Less major bleeding vs warfarin;
- Noninferior to warfarin for stroke, ACM.
- Apixaban best cut bleeding in patients with lower renal function, dabigatran in patients aged
- Rivaroxaban and apixaban performed similarly in patients with stroke, diabetes, and heart failure.
- Systematic review of 220 studies assessing stroke risk in Afib patients taking warfarin vs DOAC.
- Funding: Patient-Centered Outcomes Research Institute.
- Heterogeneous populations, outcomes.
- No trials compared DOAC types, nor factor Xa inhibitors to each other.