Use of direct oral anticoagulants to prevent stroke in atrial fibrillation

This paper studied the use of direct oral anticoagulants to prevent stroke in patients with atrial fibrillation. 

Atrial fibrillation (AF) refers to an abnormal heart rate that is irregular and usually rapid. It increases the risk of stroke (not enough blood supplying the brain). Current recommended treatments include wafarin (Coumadin) and direct oral anticoagulants (DOACs). Examples of DOACs are dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto) and edoxaban (Savaysa). They work by preventing blood from clotting. While warfarin is the mainstay for preventing stroke, it increases the risk of major bleeding. 

This review examined the use of DOACs in the prevention of stroke in AF patients.

150 mg of dabigatran twice daily was associated with lower rates of stroke than warfarin. The rate of major bleeding was similar in patients who received warfarin or 150 mg of dabigatran twice daily. There was a significantly higher rate of major bleeding from the intestines or stomach with  150 mg of dabigatran than warfarin. The rate of bleeding in the brain was significantly reduced (60%) in patients receiving dabigatran.

Rivaroxaban was as effective as warfarin for preventing stroke in patients with AF. Patients receiving rivaroxaban were 33% less likely to bleed in the brain than patients receiving warfarin. They were 50% less likely to have fatal bleeding than patients receiving wafarin. However, patients receiving rivaroxaban were more likely to experience major gastrointestinal bleeding.

Patients taking apixaban had a lower rate of stroke than patients receiving warfarin. Rates of major bleeding were 31% lower among patients receiving apixaban than warfarin.  

Edoxaban was as effective as warfarin in prevention of stroke in patients with AF. Rates of major bleeding were 20% less in patients who received edoxaban than patients who received wafarin.

The authors concluded that DOACs provide an alternative treatment option to prevent stroke in patients with atrial fibrillation. 

Different groups of patients were used in the trial. Thus it cannot be used to conclude that one drug has a definite benefit over another drug.