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.

This Week's Must Reads

Detection & Management of Resistant Hypertension, Hypertension; ePub 2018 Sep 13; Carey, et al

Does Aspirin Prevent CV Events in Older Adults?, N Engl J Med; ePub 2018 Sep 16; McNeil, et al

Timing of ICD Placement From Last Hospitalization for HF, Circulation; ePub 2018 Sep 13; Ambrosy, et al

FFR and Quality of Life After PCI, Circulation; ePub 2018 Sep 18; Nishi, et al

VTE risk for continuous cycle oral contraceptives, Li J et al. JAMA Intern Med. 2018 Oct 1. doi:10.1001/jamainternmed.2018.4251

Must Reads in Arrhythmias & EP

Effect of AF on Outcomes in Women Undergoing TAVI, Am J Cardiol; ePub 2018 Sep 7; Guedeney, et al

Psychosocial Stressors & AF in Older Women, Am J Cardiol; ePub 2018 Aug 17; Westcott, et al

Dementia Progression in Men and Women with AF, Am J Cardiol; ePub 2018 Aug 3; Golive, et al

SSRIs & Bleeding Risk in AF Patients Taking Anticoagulants, J Am Heart Assoc; ePub 2018 Jul 27; Quinn, et al

Catheter Ablation for Ventricular Arrhythmias, Am J Cardiol; ePub 2018 Jul 18; Ogunbayo, et al