NOACs vs. Warfarin in reducing CVA episodes in patients having NVAF

Abstract

For the purpose of this dissertation, a comparative account between new oral anticoagulants and Warfarin was conducted in order to identify which class of drugs is safer and more effective in reducing cerebrovascular accidents in patients having non-valvular atrial fibrillation. For this reason the following clinical inquiry was identified: “In adult patients with nonvalvular atrial fibrillation, are non-vitamin K inhibitors/New Oral Anticoagulants (Dabigatran, Apixaban, Edoxaban and Rivaroxaban) more safe and effective than Warfarin (a vitamin K inhibitor) in reducing the risk of cerebrovascular accidents?” 1. Population/P: People with Nonvalvular Atrial Fibrillation/NVAF. 2. Intervention/I: Non-Vitamin K Inhibitors/New Oral Anticoagulants/NOACs. 3. Comparison/C: Warfarin. 4. Outcome/O: Reduction in Cerebrovascular Accidents/CVA. Given the comparative nature of the inquiry, selected studies had to compare new oral anticoagulants with Warfarin, having the following criteria: Inclusion Criteria: participants signed an informed consent; postmenopausal/ sterile/abstinent participants; atrial fibrillation individuals aged >18 years; subjects may be diagnosed with chronic kidney disease; studies published after 2005. Exclusion Criteria: individuals with liver disease and/or having contraindications to anticoagulants; anaemic individuals; pregnant/breast-feeding mothers; studies incorporating haemorrhagic individuals. The final outcome of the search yielded a total of nine articles (four meta-analysis and systematic reviews and five meta-analysis of randomised controlled trials). Each article was appraised using the Oxford critical appraisal skills program tool. The main results show that new oral anticoagulants substantially decreased cerebrovascular accidents, systemic embolic events, intracranial bleeding and mortality; with their only downfall being an increased incidence of gastrointestinal bleeding. For these reasons, several implications for practice, management, education and research; including the importance of long-term self-monitoring of blood pressure (shown to reduce hospitalisations), assessment for creatinine clearance via blood investigations, importance of pedagogy and the need for further research in identifying new oral anticoagulant antidotes were recommended.