Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation

Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation

“…In a Cochrane meta‐analysis of direct thrombin inhibitors, it was found that dabigatran 150 mg twice daily was superior to warfarin in the prevention of vascular death and ischaemic events [odds ratio (OR) 0.86, 95% CI 0.75–0.99] and direct thrombin inhibitors were associated with significantly lower rates of fatal and nonfatal major bleeding events, including haemorrhagic strokes (OR 0.87, 95% CI 0.78–0.97) . A meta‐analysis of the factor Xa inhibitors has also shown superiority over warfarin in the prevention of ischaemic and haemorrhagic stroke (OR 0.78, 95% CI 0.69–0.89) and systemic embolic events (OR 0.53, 95% CI 0.32–0.87), and a reduced incidence of intracranial haemorrhage (OR 0.56, 95% CI 0.45–0.70) . However, the evidence for a reduction in major haemorrhages with the factor Xa inhibitors is less robust due to heterogeneity within the studies included in the review ; re‐analysis with data from the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48 (ENGAGE AF‐TIMI 48) study may be beneficial.…”

“…A meta‐analysis of the factor Xa inhibitors has also shown superiority over warfarin in the prevention of ischaemic and haemorrhagic stroke (OR 0.78, 95% CI 0.69–0.89) and systemic embolic events (OR 0.53, 95% CI 0.32–0.87), and a reduced incidence of intracranial haemorrhage (OR 0.56, 95% CI 0.45–0.70) . However, the evidence for a reduction in major haemorrhages with the factor Xa inhibitors is less robust due to heterogeneity within the studies included in the review ; re‐analysis with data from the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation–Thrombolysis in Myocardial Infarction 48 (ENGAGE AF‐TIMI 48) study may be beneficial.…”

Bleeding Risk and Mortality of Edoxaban: A Pooled Meta-Analysis of Randomized Controlled Trials

“…However, VKAs exhibit a considerable variability in dose response among patients, participate in multiple food and drug interactions, and have a narrow therapeutic window [3], [4]. These limitations has prompted the development of a series of new oral anticoagulants (OACs) as alternatives to VKAs, including direct thrombin inhibitors such as dabigatran as well as direct factor Xa inhibitors including rivaroxaban, apixaban, and edoxaban.…”