Anticoagulation in Atrial Fibrillation: A retrospective integrative analysis of the hemorrhagic risks of Apixaban and Warfarin
DOI:
https://doi.org/10.11606/issn.1679-9836.v104i4e-207053Keywords:
warfarin, apixaban, atrial fibrillation, Hemorrhage, Myocardial infarctionAbstract
Introduction: Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting approximately 2% of the global population, especially older adults. It is strongly associated with an increased risk of thromboembolic events, including stroke and myocardial infarction. Oral anticoagulation remains the cornerstone of prevention, with warfarin historically serving as the standard therapy. However, warfarin requires frequent laboratory monitoring, exhibits high interindividual variability, and poses a substantial risk of bleeding. In this context, direct oral anticoagulants (DOACs), such as apixaban, have emerged as safer and more manageable alternatives. Objectives: To compare the bleeding events related to apixaban and warfarin in the prevention of thromboembolic events among patients with non-valvular atrial fibrillation. Methods: A retrospective integrative review was conducted using articles published between 2017 and 2022, indexed in SciELO-Brasil, Medline/PubMed, and NCBI. The search included the descriptors “Warfarin,” “Apixaban,” “Atrial Fibrillation,” “Hemorrhage,” and “Myocardial Infarction,” combined using the Boolean operators AND and OR. Results: The ARISTOTLE trial was identified as the most comprehensive randomized controlled trial comparing the two drugs, involving 18,201 patients with a mean follow-up of 20 months. The annual rate of major bleeding events was 3.09% in the warfarin group (n=426) versus 2.13% in the apixaban group (n=327). Apixaban was also associated with lower rates of intracranial hemorrhage and treatment discontinuation. These findings were corroborated by subsequent observational studies, including those focused on elderly populations. Conclusion: Apixaban demonstrated superior efficacy and safety compared to warfarin for preventing hemorrhagic and thromboembolic events in patients with non-valvular AF. Its fixed dosing regimen, favorable safety profile, and lack of need for routine laboratory monitoring support its use as a first-line anticoagulant in contemporary clinical practice.
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