Direct-Acting Oral Anticoagulants Have a Lower Mortality than Warfarin for Nonvalvular Afib

by Joseph Esherick, M.D., FAAFP, FHM

Compared with warfarin, the new agents significantly reduced all-cause and vascular mortality.


The new direct-acting oral anticoagulants (DOACs; dabigatran, rivaroxaban, apixaban, and edoxaban) have been found to be noninferior to vitamin K antagonists in clinical trials of stroke prevention in patients with atrial fibrillation. However, none of the trials has been large enough to determine whether DOACs decrease mortality to a greater extent than warfarin.

Now, investigators performed a meta-analysis of four phase III clinical trials comprising 71,683 patients with nonvalvular atrial fibrillation.

In patients with nonvalvular atrial fibrillation, DOAC therapy was associated with significant declines in all-cause mortality and vascular mortality (P<0.0001 for each). In addition, there was a striking decrease in bleeding mortality (relative risk, 0.54; P<0.0001), which was mainly due to a reduction in intracranial bleeding (RR, 0.42; P<0.00001).


 Nonvalvular atrial fibrillation



  1. Liew A et al. Comparing mortality in patients with atrial fibrillation who are receiving a direct-acting oral anticoagulant or warfarin: A meta-analysis of randomized trials. J Thromb Haemost 2014 Sep12:1419