Direct-Acting Oral Anticoagulants vs. Warfarin for Preventing Strokes in Patients with Atrial Fibrillation

Direct-acting oral anticoagulants (DOACs) have several advantages over warfarin for treating patients with atrial fibrillation, but DOACs are expensive. In this systematic review and network meta-analysis of 23 randomized trials, investigators compared DOACs with warfarin and with each other in nearly 95,000 atrial fibrillation patients. DOACs included in the analysis were apixaban (5 mg twice daily), dabigatran (110 mg or 150 mg twice daily), edoxaban (30−60 mg once daily), and rivaroxaban (20 mg once daily).

The following outcomes were statistically significantly different for DOACs compared with warfarin:

• Risk for stroke or systemic embolism was lower for apixaban and high-dose dabigatran.

• Risk for all-cause death was lower for apixaban and…