Clinical Edge

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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.

Citation:

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.