Date of Award
2026
Document Type
Capstone
Degree Name
Master of Science (MS)
Department
Physician Assistant Studies
Committee Chair
LaDonna Clark
Abstract
Introduction: Atrial fibrillation is one of the most common cardiac arrhythmias in adults. This condition greatly increases a patient’s risk for ischemic stroke and is responsible for one-third ischemic strokes. Current international guidelines recommend the use of oral anticoagulants for stroke prevention in patients with atrial fibrillation. The purpose of this review is to analyze the current literature directly comparing the safety and efficacy of direct oral anticoagulants and warfarin at preventing stroke.
Methods: The PubMed database was searched for the following key terms: vitamin k antagonist, direct oral anticoagulants, stroke, and atrial fibrillation. Boolean operators and MeSH terms related to these key words were added to the search. These results were then filtered only to include free full text articles, meta-analyses, and systematic reviews between 2020 – 2025. These studies were further screened for methodology and relevance to my PICO question, leading to four high-quality meta-analyses for review.
Results: The authors of the four meta-analyses, comparing direct oral anticoagulants and warfarin, demonstrated significant increases in efficacy of direct oral anticoagulants versus warfarin at preventing stroke in patients with atrial fibrillation. The statistical analyses performed in the studies suggested a decreased risk for hemorrhagic stroke and intercranial bleeding with direct oral anticoagulants.
Discussion: Results from the four meta-analyses demonstrated that direct oral anticoagulants are more effective than warfarin at stroke prevention and safer as they do not increase patient risk for major bleeding. This evidence suggests that direct oral anticoagulants are superior to warfarin for stroke prevention in patients with atrial fibrillation. Further research is required to standardize dosages and evaluate which direct oral anticoagulant is the most effective.
Recommended Citation
Gentry KL. Safety and Efficacy of Stroke Prevention with Warfarin vs. Direct Oral Anticoagulants in Patients with Atrial Fibrillation: A Clinical Review. The PA Department Journal of Medical Science. 2026. https://digitalcommons.gardner-webb.edu/pa-department-journal-of-medical-science/41
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