ABSTRACT
Background: Atrial fibrillation (AF) had been identified as the most prevalent sustained cardiac rhythm disorder with a fivefold greater risk of stroke, systemic embolism and death. Until recently, stroke prevention in patients with AF has primarily relied on anticoagulation therapy. Vitamin K antagonists including warfarin used to be the standard of care, but the advent of direct oral anticoagulants (DOACs) had revolutionized treatment with its superiority in safety, efficacy, and convenience. Nevertheless, clinical considerations, e.g., personalized dosing, bleeding risk, therapy adherence still were exerting an impact on therapeutic decisions.
Objectives: The study sought to review the developing landscape of anticoagulation in AF, focusing on existing treatment options, recent outcomes and emerging directions in the management of AF.
Methods: This was a retrospective review conducted at Shifa International Hospital, Islamabad from April, 2024 to March, 2025. The study population consisted of 90 patients with confirmed AF and established anticoagulation treatment. Demographics, anticoagulation treatment, treatment response, and complications were extracted from electronic health records. DATA COLLECTIO A meta-analysis had been carried out to compare the efficacy and safety of warfarin with DOACs in the real-life clinical practice.
Results: In 90 patients, 38 (42.2%) were treated with warfarin while 52 (57.8%) were prescribed DOACs. Patients taking DOACs had shown better therapeutic stability, 84.6% of them had stable anticoagulation dose vs 65.7% in warfarin group. The incidence of major bleeding was previously lower in the DOAC group (5.7% vs. 13.1%). The risk of stroke was slightly higher in the DOAC group (3.8 per cent) compared to the warfarin group (7.8 per cent). In general, the clinical safety of DOACs had been better and efficacy outcomes remained similar, if not superior, to warfarin.
Conclusion: The landscape of anticoagulation therapy in AF has evolved further since the study reported with DOACs being the safer and more effective alternative to warfarin. However, personalized therapy choice, tracking paradigms, as well as long-term compliance had continued to be fundamental. Future research needs to address the patient-centered approach, cost-effectiveness, and the incorporation of new agents to further improve the outcomes of AF management.
Keywords: Atrial fibrillation, Anticoagulation therapy, Warfarin, Direct oral anticoagulants, Stroke prevention, Clinical outcomes.