Warfarin versus DOACs in the prevention of thromboembolic stroke in patients with Afib. : Warfarin versus DOACs in the prevention of thromboembolic stroke in patients with Afib.

Abstract

ABSTRACT Preventing thromboembolic (TE) events “such as stroke” is an important part of managing patients with non-valvular atrial fibrillation (Afib). Over the last 50 years, oral anticoagulant treatment with the Vitamin K Antagonist (VKA) warfarin has played a crucial role in the secondary prevention of stroke for patients with Afib. Direct oral anticoagulant (DOACs), and their dominance over warfarin has arrived for treatment of Afib in the context of stroke prevention and research indicates DOACs are, for the most part, superior to warfarin in the secondary prevention of stroke in patients with non-valvular Afib. But what does the evidence tell us about risk versus benefits? The purpose of this review of literature is to conduct a systematic review of the advantages and disadvantages of DOACs, namely dabigatran, rivaroxaban, apixaban and edoxaban compared with warfarin in patients with (non-valvular) Afib. In general, this review demonstrates the advantages of DOACs compared with warfarin including, DOACs are associated with lower rates of life-threatening and intracranial bleeding, DOACs have a rapid onset with peak effect within a few hours, they have predictable dose responses, thus eliminating the need for routine monitoring; and they have few, if any, important food or drug interactions, thus simplifying management. The findings of this systematic literature review suggest that in the secondary prevention of stroke in patients with non-valvular Afib, DOACs, demonstrate a significant advantage and enhanced safety profile over warfarin in reducing the risk of thromboembolic stroke compared with warfarin. As such, DOACs should be considered first-line therapy in the secondary prevention of stroke in patients with non-valvular Afib.