Comparison of the Efficacy and Safety of Apixaban and Warfarin in the Prevention of Stroke in Patients With Non-valvular Atrial Fibrillation: A Meta-Analysis

Abstract

Atrial fibrillation is an irregular heart rhythm, and it is one of the most common cardiac arrhythmias. It is associated with a five times increase in the risk of stroke. Anti-coagulants are prescribed routinely to prevent strokes, especially in patients with atrial fibrillation for many years decreasing the risk of stroke among patients with atrial fibrillation. Non-vitamin K oral anticoagulants especially apixaban and rivaroxaban are frequently used and they are considered to be safe and more effective than warfarin. The aim of this metaanalysis is to compare the efficacy and safety of apixaban and warfarin in preventing stroke among patients with non-valvular arterial fibrillation. The current meta-analysis was conducted using the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was done using databases, including PubMed, EMBASE, and Cochrane Library, with no restrictions on language and year of publication. The current meta-analysis included randomized control trials and non-randomized control trials (prospective and retrospective cohort studies) comparing the efficacy and safety of apixaban and warfarin in preventing stroke in patients with non-valvular atrial fibrillation. The primary efficacy outcome was stroke or systemic embolism while the primary safety outcome was major bleeding events. Overall, nine articles were included in the current meta-analysis with a pooled sample size of 267998 patients with non-valvular atrial fibrillation. The administration of apixaban was associated with a significant decrease in stroke or systemic embolism (RR: 0.77, 95% CI: 0.67-0.90) and major bleeding events (RR=0.63, 95% CI: 0.58-0.68) as compared to warfarin. However, no significant difference was reported in all-cause mortality (RR=0.80, 95% CI: 0.30-2.14) between the two groups. The current meta-analysis concluded that apixaban, compared to warfarin in patients with non-valvular atrial fibrillation showed a reduction in stroke and systemic embolism. Apixaban has also a better safety profile in terms of reduction in overall major bleeding events.

Comparison of Effectiveness and Safety of Direct-Acting Oral Anticoagulants and Vitamin K Agonists in Patients With Atrial Fibrillation and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

“…Prior research has underscored the established advantages of DOACs over warfarin in individuals with NVAF [ 22 ]. Nevertheless, the presence of ESRD complicates the intricate dynamics of bleeding and coagulation pathways, leading to the exclusion of such patients from major DOAC clinical trials.…”