Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

DOACs vs Warfarin in Non-Valvular AF Patients

Circulation; ePub 2018 May 24; Nazha, et al

In patients with non-valvular atrial fibrillation (NVAF), the short-term safety efficacy of direct oral anticoagulants (DOACs) and warfarin are not different periprocedurally; however, under an uninterrupted anticoagulation strategy, DOACs are associated with a lower risk of major bleeding compared with warfarin. This according to a meta-analysis of 4 phase III trials comparing DOACs with warfarin in the periprocedural period among NAVF patients. DOACs as a group and warfarin were compared in terms of the 30-day pooled risk for stroke/systemic embolism (SSE), major bleed (MB), and death, according to whether the study drug was interrupted or not periprocedurally. Researchers found:

  • In the uninterrupted anticoagulant strategy, there were no differences in the rates of SSE and death between DOACs and warfarin.
  • DOACs are associated with a 38% lower risk of MB compared with warfarin under an uninterrupted anticoagulation strategy.
  • Under an interrupted strategy, there was no significant difference between DOACs vs warfarin for SSE, MB, and death.


Nazha B, Pandya B, Cohen J, et al. Periprocedural outcomes of direct oral anticoagulants vs. warfarin in non-valvular atrial fibrillation: A meta-analysis of phase III trials. [Published online ahead of print May 24, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.117.031457.