Efficacy and Safety of Apixaban versus Warfarin in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis

Background: The real-world evidence-based recommendation is still needed to improve Atrial fibrillation (AF) management in anticoagulant administration. Objectives: This study aimed to disclose apixaban safety and efficacy profile compared with warfarin in a real-world population. Methods: We collected data from articles worldwide studies comparing apixaban and warfarin in non-valvular atrial fibrillation (NVAF) patients. Data were retrieved from studies published in Embase ProQuest, PubMed, and Cochrane based on inclusion criteria. Data analysis was carried out using Review Manager Version 5.4.1 (Cochrane, Copenhagen, Denmark) using Mantel-Haenszel statistical method for categorical data to measure relative risk (RR) and 95% confidence interval (CI). We used a random-effect analysis model if p for heterogeneity was<0.1 and a fixed-effect analysis model if p for heterogeneity (pHet) was 0.1. Results: Apixaban showed a benefit in preventing ischemic stroke (RR=0.51; 95% CI=0.40-0.66; p<0.01), ischemic stroke/systemic embolism (RR=0.63; 95% CI=0.50-0.81; p<0.01), and all-cause mortality (RR=0.54; 95% CI=0.40-0.74; p<0.01) compared to warfarin. Apixaban also showed benefit to prevent major bleeding (RR=0.49; 95% CI=0.41-0.58; p <0.01), gastrointestinal (GI) bleeding (RR=0.46; 95% CI=0.36-0.60; p<0.01), and intracranial hemorrhage (RR=0.45; 95% CI=0.36-0.57; p<0.01) compared to warfarin. Conclusion: Apixaban, compared to warfarin, has superior efficacy and safety. Apixaban has a safer profile than warfarin in reducing the risk of major bleeding, GI bleeding, and intracranial hemorrhage in AF patients.