Table 4. Oral Anticoagulants for Stroke Prevention in Patients with
Atrial Fibrillation
Medication
(30-day
supply) Dose
a
Benefits
b
Risks
b
Warfarin Varies
(Titrated to
INR)
• Inexpensive
• Reversal agent available
• Can use in end-stage renal
disease (CrCl <15)
• Well studied
• Bleeding
• Contraindicated in
pregnancy
• Many potential food and
drug interactions
Apixaban 5 mg bid
↓ Stroke
↓ Major bleeding
↓ Intracranial hemorrhage
↓ All-cause mortality
• No reversal agent
• Caution with use in end-
stage renal disease
Dabigatran 150 mg bid
↓ Stroke
↓ Intracranial hemorrhage
• Reversal agent available
↑ MI
↑ GI bleeding
• Not approved for use in
end-stage renal disease
Edoxaban 60 mg daily
↓ Major bleeding
↓ Cardiovascular mortality
• No reversal agent
• Not approved for use in
end-stage renal disease
Rivaroxaban 20 mg daily
↓ Intracranial hemorrhage
• Bleeding (similar to
warfarin)
• No reversal agent
• Caution with use in
end-stage renal disease
a
Dose of non-vitamin K antagonist oral anticoagulant (NOAC) should be adjusted for patients with
renal insufficiency.
b
Benefits/risks of NOACs compared to warfarin.
Table 5. Increased Risk of Major Bleeding with Dual Therapy
Treatment Increased Risk (95% CI) Number Needed to Harm
Warfarin +
antiplatelet therapy
HR 1.5 (1.22–1.86) 55
Dabigatran 150 mg +
antiplatelet therapy
HR 1.81 (1.46–2.24) 58
Dabigatran 110 mg +
antiplatelet therapy
HR 1.53 (1.21–1.92) 62