Abstract Body:

Background
Atrial fibrillation (AF) patients carry a high risk of stroke, and treatment related bleeding complications. Evidence for the safety and efficacy of anticoagulation remains sparse with conflicting results.
Objective
We sought to investigate the effectiveness and safety of direct oral anticoagulant (DOAC) versus warfarin in atrial fibrillation patients.
Methods
We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) from inspection until July 30th, 2024, without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.
Results
A total of 7 RCTs with 79,001 patients were included (46069 in DOAC and 32932 in the warfarin group) in the analysis. The mean age of the patients in DOAC and the warfarin groups was 72.8 and 72.9 years, respectively. Pooled analysis of primary and secondary endpoints showed that DOAC significantly reduced the risk of stroke or systemic embolism by 18% (OR, 0.82(95%CI: 0.75-0.91), P<0.01), stroke by 19% (OR, 0.81(95%CI: 0.68-0.97), P=0.02), and hemorrhagic stroke by 57% (OR, 0.43(95%CI: 0.33-0.56), P<0.01) when compared with warfarin. However, the risk of ischemic stroke (OR, 0.96(95%CI: 0.78-1.18), P=0.69), major bleeding (OR, 0.84(95%CI: 0.67-1.06), P=0.14) and myocardial infarction (OR, 1.07(95%CI: 0.89-1.28), P=0.45) was comparable between DOAC and the warfarin group of patients. The use of DOACs was associated with lower odds of all-cause mortality (OR, 0.91(95%CI: 0.85-0.97), P<0.01) when compared with the warfarin group of patients.
Conclusion
In this comprehensive analysis of randomized controlled trials data, the use of DOACs was associated with reduction in stroke or systemic embolism, hemorrhagic stroke, and all cause mortality, compared with warfarin therapy. Major bleeding risk was comparable between both groups of patients.