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Atrial fibrillation is a common cause for stroke. Vitamin K antagonists such as warfarin are an effective prophylactic medication to prevent stroke in patients with atrial fibrillation. Warfarin, however, has a narrow therapeutic index, reacts with certain foods, increases bleeding risks, and requires frequent monitoring. New medications have been developed to prevent clot formation while avoiding the negative effects of warfarin. The purpose of this study was to compare direct factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban) versus warfarin in stroke prevention, safety, and cost.

The review of literature analyzed studies comparing warfarin and direct factor Xa inhibitors in patients with atrial fibrillation. Study outcomes included stroke prevention, bleeding risks, and cost. Analysis on antidote/reversal agents were also examined.

Direct factor Xa inhibitors decreased stroke compared with warfarin with an odds reduction of 0.81 and decreased intracranial hemorrhages with an odds reduction of 0.56 (Bruins & Berge, 2013). Direct factor Xa inhibitors were more cost effective, but with higher out of pocket expense. Direct factor Xa inhibitors have no reversal agent. Despite no antidote, research showed lower rates of fatal bleeding deaths associated with direct factor Xa inhibitor use compared to warfarin.


Physician Assistant Studies

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Master of Physician Assistant Studies (MPAS)

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Anticoagulants -- economics; Anticoagulants -- therapeutic use; Stroke -- prevention & control; Comparative Study


Cardiovascular Diseases

Direct Factor Xa Inhibitors Versus Warfarin in Non-Valvular Atrial Fibrillation: Efficacy, Safety, Cost, and Reversibility