Comparative Effectiveness of Novel Oral Anticoagulants Versus Traditional Anticoagulants in Atrial Fibrillation Patients: A Narrative Review NOACs vs VKAs in Atrial Fibrillation
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Abstract
Background: Atrial fibrillation (AF) increases the risk of stroke and systemic embolism, necessitating anticoagulation therapy. Traditional vitamin K antagonists (VKAs) like warfarin have limitations, prompting the use of novel oral anticoagulants (NOACs), which offer advantages like predictable dosing and fewer interactions.
Objective: To compare the effectiveness and safety of NOACs versus VKAs in AF patients.
Methods: A comprehensive literature search was conducted across PubMed, Cochrane CENTRAL, EMBASE, Web of Science, and Scopus to identify randomized controlled trials (RCTs) and observational studies published between 2014 and 2024. Data were synthesized using a random-effects model, with subgroup analyses based on patient characteristics. The primary outcomes included stroke, systemic embolism, and major bleeding.
Results: A total of 42 studies involving approximately 250,000 patients met the inclusion criteria. NOACs reduced the risk of stroke and systemic embolism by 19% (RR 0.81, 95% CI 0.75-0.87) and major bleeding by 16% (RR 0.84, 95% CI 0.79-0.90) compared to VKAs. NOACs also halved the risk of intracranial hemorrhage (RR 0.50, 95% CI 0.42-0.59).
Conclusion: NOACs offer comparable or superior efficacy in stroke prevention with a better safety profile than VKAs, supporting their broader adoption in clinical practice for AF patients.
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