For Atrial Fibrillation, New Oral Anticoagulants Are More Effective and Safer than Warfarin

Three new oral anticoagulants — the thrombin inhibitor dabigatran (Pradaxa) and the factor Xa inhibitors apixaban (Eliquis) and rivaroxaban (Xarelto) — are approved for preventing stroke and systemic embolism in patients with atrial fibrillation. Edoxaban, a factor Xa inhibitor that is not yet approved by the FDA, is noninferior to warfarin for these indications (NEJM JW Gen Med Nov 19 2013). Now, researchers report a meta-analysis of the four major clinical trials in which these newer anticoagulants were compared head to head with warfarin in 72,000 patients (mean age, 72) with atrial fibrillation. Median follow-up was 2 to 4 years.

Compared with warfarin, the newer agents were associated with significantly fewer strokes and systemic emboli…