Safety and Efficacy of New Oral Anticoagulants in Patients with Atrial Fibrillation: A Literature Review

Abstract

Background: TraditionallyVitamin K antagonists (VKAs), such as warfarin, have been used to reduce the risks of stroke and systemic embolism in patients with atrial fibrillation (AF). However, they are associated with increased risk of haemorrhage. Thus, there is a need for new oral anticoagulant agents that are effective, safe, and convenient to use. Recent, observational and randomized controlled clinical trials, have examined the long-term use and efficacy of new oral anticoagulants. However, their results pertaining to important secondary efi¬cacy end points as well as safety outcomes were inconclusive. Aim: We, therefore, performed a systematic review to examine the long-term efi¬cacy and safety of the new oral anticoagulants namely; dabigatran, rivaroxaban and apixaban in patients with AF. Methods: In total 286 abstracts have been screened and 21 articles have been selected and considered as relevant for this epidemiological review. The primary efi¬cacy endpoint was the incidence of stroke or systemic embolism. The primary safety endpoint was the incidence of major bleeding. Results: We observed that dabigatran and rivaroxaban are more efi¬cacious than warfarin for the prevention of stroke, death and systemic embolism. Also, they decrease the risk for intracranial bleeding and appear to have a favorable safety proi¬le, making them promising alternatives to warfarin. Conclusions: Overall, our results support the use of the new oral anticoagulants as alternatives to warfarin for long-term anticoagulation therapy in patients with AF.