Evidence Update on Direct Oral Anticoagulants for Atrial Fibrillation

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Oral anticoagulation is an important intervention to prevent thromboembolic complications of this condition. Drug options include vitamin K antagonists (VKAs), such as warfarin, and direct oral anticoagulants (DOACs), such as apixaban, dabigatran, edoxaban, and rivaroxaban.

Updated American (2019), Canadian (2020), and European (2020) guidelines all recommend the use of DOACs over VKAs to prevent stroke and other thromboembolic complications in patients with non-valvular AF. These recommendations are based on evidence of similar or improved efficacy of DOACs in preventing stroke, lowering the risk of intracerebral hemorrhage, and reducing mortality, compared with VKAs.

A focused literature search was conducted to retrieve new evidence (systematic reviews, meta-analyses, health technology assessments) published since the North American and European guidelines on AF were updated. No new evidence was retrieved. As such, evidence reviewed by the American, Canadian, and European guidelines is still current.