Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update | Effective Health Care Program

Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update | Effective Health Care Program

Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

Key Messages

• CHADS2, CHA2DS2-VASc, and ABC risk scores have the best evidence to support prediction of stroke events.
• HAS-BLED has the best evidence to support prediction of bleeding risk.
• Imaging tools for stroke prediction require further evidence.
• Dabigatran (150 mg dose) is superior to warfarin in preventing stroke or systemic embolism, with no evidence for a difference in major bleeding. There may also be no evidence for a difference in myocardial infarction or all-cause mortality.
• Apixaban is superior to warfarin in preventing stroke or systemic embolism. Apixaban also has less risk for major bleeding and may also decrease all-cause mortality compared to warfarin.
• Rivaroxaban may be similar to warfarin in preventing stroke or systemic embolism and in risk of major bleeding. Rivaroxaban is most likely similar to warfarin in the rate of all-cause mortality. However, inconsistent with the randomized controlled trial (RCT) findings, observational studies showed rivaroxaban may better prevent stroke or systemic embolism and may have a higher risk of major bleeding.
• Edoxaban is most likely similar to warfarin in preventing stroke or systemic embolism and also most likely has less risk for major bleeding and hemorrhagic stroke than warfarin.
• Further RCTs directly comparing oral anticoagulants, including thrombin inhibitors and individual Xa inhibitors, are needed.