Abstract

Atrial fibrillation (AF) is a prevalent clinical condition associated with a heightened risk of stroke and systemic thromboembolism. In contrast to traditional vitamin K antagonists like warfarin, direct oral anticoagulants (DOACs) have demonstrated superior efficacy and safety profiles. This systematic review evaluated the comparative effectiveness of anticoagulation therapy in AF patients by analyzing 14 studies, comprising both cohort studies and randomized controlled trials conducted in the USA, Europe, and Asia. The review synthesized data on key clinical outcomes, including stroke prevention, mortality, and bleeding events, to assess the net clinical benefit of treatment. The pooled analysis found that, compared to warfarin, DOACs were associated with a significantly lower risk of ischemic stroke and major bleeding complications. Specifically, the risk of ischemic stroke or systemic embolism was substantially reduced in patients receiving anticoagulants [risk ratio (RR): 0.20, p = 0.0135). While the analysis did not reveal statistically significant differences in total mortality (RR: 0.48, p = 0.3986) or recurrent intracranial hemorrhage (RR: 0.73, p = 0.6748), the combination of warfarin and DOAC data indicated the lowest proportion of major bleeding events (0.02, p < 0.0001). These findings support the preferential use of DOACs over warfarin for stroke prevention in AF, given their association with a reduced risk of significant bleeding. Although DOACs represent a safer therapeutic option, particularly for patients at high bleeding risk, the absence of a significant mortality benefit underscores the necessity for tailored anticoagulation management. Further research is required to analyze long-term outcomes and the effects within specific patient subgroups.

Key words: Effectiveness, anticoagulation therapy, atrial fibrillation, systematic review, direct oral anticoagulants