Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation: A Systematic Review and Meta-Analysis
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Background and Purpose— The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation. Methods— We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs. Results— From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64–0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents ( P <0.00001 for all comparisons). Conclusions— Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.
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The presence of unaccountable confounders must be considered when interpreting the results, especially given the nonrandomized designs, despite analyses to reduce confounders.
“At the same time, the presence of unaccountable confounders must be considered when interpreting our results, especially in light of the nonrandomized designs, despite various analyses performed in the included studies to reduce the confounders. 20”
From Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world (2019) · cites this paper as [20]
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References 38 · Cited by 126
- Authors
- Proietti, M., Romanazzi, I., Romiti, G. F., Farcomeni, A., & Lip, G. Y. H.
- Affiliations
- Mario Negri Institute for Pharmacological Research (IT)
- Venue
- Stroke
- Published
- 2018-01
- Volume
- 49
- Issue
- 1
- Pages
- 98-106
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2768642390
- Cited by
- 126
- References
- 38
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 13 · 2023: 15 · 2022: 18 · 2021: 21 · 2020: 14 · 2019: 24 · 2018: 9
- FWCI
- 9.93
- Type
- journal article
- Language
- en
- Open access
- green
- vbn.aau.dk
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- apixaban, atrial fibrillation, stroke prevention, direct oral anticoagulants, warfarin, dabigatran, rivaroxaban, thromboembolic events, major bleeding, intracranial hemorrhage, gastrointestinal bleeding, real-world effectiveness and safety
- MeSH terms
- Rivaroxaban, Anticoagulants, Atrial Fibrillation, Clinical Trials as Topic, Female, Humans, Male, Polymers, Pyrazoles, Pyridones, Risk Factors, Saliva, Artificial, Vitamin K, Warfarin, Intracranial Hemorrhages, Stroke
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