ANTICOAGULANT THERAPIES IN PATIENTS WITH ATRIAL FIBRILLATION AND HIGH RISK OF BLEEDING: COMPARISON OF NEW ORAL ANTICOAGULANTS

Abstract

Atrial fibrillation (AF) is a common arrhythmia that significantly increases the risk of stroke and other thromboembolic complications, requiring systemic anticoagulation for most patients. This study performed an integrative review to compare the efficacy and safety of novel oral anticoagulants (NOACs) with vitamin K antagonists (VKAs) in patients with AF and high risk of bleeding. Analysis of 25 studies, including randomized controlled trials, systematic reviews, and observational studies, demonstrated that NOACs, particularly apixaban, offer similar or superior efficacy in preventing thromboembolic events and a more favorable safety profile compared with VKAs, especially regarding the reduction of the risk of intracranial bleeding. However, the risk of gastrointestinal bleeding was higher with some NOACs, such as dabigatran and rivaroxaban. The availability of specific reversal agents for NOACs improves safety in emergency situations, although issues of cost and access must be considered. It is concluded that the choice between NOACs and VKAs should be personalized, taking into account the individual patient's risk profile and clinical circumstances.