Background: Atrial fibrillation leads to increased risk of systemic embolism (SE) and stroke. To decrease the occurrence of stroke/SE, anticoagulation is routinely prescribed. Recently, non-vitamin K anticoagulants like apixaban and rivaroxaban have become more popular and are preferred over warfarin. We here compare the efficacy and safety of apixaban with warfarin.
Methods: Eligible participants were adults diagnosed with non-valvular atrial fibrillation. The intervention was apixaban and comparator was warfarin. The primary efficacy endpoint is the first admission with systemic embolism or stroke and primary safety outcome is occurrence of major bleeding. Relevant studies were searched in Cochrane Central Register of Controlled Trials, MEDLINE, PUBMED and clinicaltrials.gov. The included articles were independently reviewed by two authors. The risk of bias of included studies were assessed using Cochrane risk of bias tool and SIGN methodology. Revman software was used to assess effect size and perform metanalysis.
Results: 102 potential articles were found after the systematic search. The full texts of 15 articles were retrieved for assessment of eligibility. 10 articles were excluded after full text review. Five articles met the inclusion criteria.
No significant difference in reducing stroke and/or systemic embolism when comparing apixaban with coumadin (risk ratio, 0.93; 95% confidence interval [CI], 0.70 – 1.24; Figure 1)
Coumadin was associated with significantly higher risk of bleeding when compared to apixaban (risk ratio, 0.58; 95% confidence interval [CI], 0.52 – 0.66; Figure 2)
Conclusions: Apixaban was found to be superior to warfarin in terms of safety. The risks and benefits of individual anti-coagulants should be identified carefully and discussed with the patient before initiation.
