Abstract
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.
Highlights
BackgroundThe number of patients with atrial fibrillation (AF) who need stroke prevention continues to rise
There is no need to monitor their effects by checking the international normalized ratio (INR). This current review shows that xabans are at least as safe as warfarin in the elderly, patients with impaired liver and renal function, and in patients with a CHA2DS2-VASc score 2 or greater
The study found that like major bleedings and non-major bleedings were more common in patients treated with warfarin vs. apixaban (9.4 vs. 6.4 per 100 patient-years)
Summary
The number of patients with atrial fibrillation (AF) who need stroke prevention continues to rise. The prevalence of AF increases with age and is associated with a higher risk of ischemic stroke. The use of warfarin reduces the risk of ischemic stroke in patients with AF, but they need frequent monitoring and dose adjustment [1]. Ischemic stroke is considered as a focal neurological deficit from non-traumatic and nonhemorrhagic causes. AF is the cause of ischemic stroke in 15% of all ages and 30% of people over 80 years of age. The risk of ischemic stroke increases significantly with anticoagulant cessation [2]
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