A comparison of front-line oral anticoagulants for the treatment of non-valvular atrial fibrillation: effectiveness and safety of direct oral anticoagulants in the FANTASIIA registry

ABSTRACT

Introduction

For a long time, vitamin K antagonists (VKA) were the only oral anticoagulation therapy available to reduce adverse events in atrial fibrillation (AF) patients. Direct-acting oral anticoagulants (DOAC) are at least as effective and safe as VKA with few drug interactions, rapid onset, and short half-life. Four DOACs, dabigatran, apixaban, rivaroxaban, and edoxaban, have demonstrated efficacy and safety for treatment in AF patients.

Areas Covered

The purpose of this review article is to analyze the current evidence in clinical trials and in real-world populations and performed a new analysis with the estimated effect of those DOACs over the VKA population from the FANTASIIA registry.

Expert Opinion

In the absence of randomized, controlled head-to-head comparisons between DOACs, high-quality observational data can provide useful information on the comparative effectiveness of DOACs. Current clinical guidelines recommend the management of oral anticoagulation in AF patients with DOACs over VKA for stroke prevention; however, many guidelines generally do not suggest a specific DOAC choice in clinical practice. The revised evidence in this manuscript and our real experience reflects that apixaban and dabigatran show the best efficacy and safety profile.

KEYWORDS:

• Atrial fibrillation
• oral anticoagulation
• antithrombotic therapy
• Direct-acting oral anticoagulants

Declaration of interest

M.A. Esteve-Pastor holds a competitive Rio Hortega research and assistance contract, granted by the State Research Agency (Ministry of Science and Innovation of Spain) in the 2019 call (ref. CM19/00089).

J.M. Rivera-Caravaca has received a grant from Sociedad Española de Trombosis y Hemostasia (grant for short international training stays 2020), and the First Contact Initiative Grant 2020 from the European Society of Cardiology Council on Basic Cardiovascular Science. J.M. Rivera-Caravaca holds a competitive Juan de la Cierva-Training postdoctoral contract, granted by the State Research Agency (Ministry of Science and Innovation of Spain) in the 2019 call (ref. FJC2019-039717-I).

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2022.2109961

Additional information

Funding

The FANTASIIA registry was funded by an unconditional grant from Pfizer/Bristol-Myers Squibb and by grants from the Instituto de Salud Carlos III (Madrid)-FEDER (RD16/11/00420, RD12/0042/0068, RD12/0042/0010, RD12/0042/0069, and RD12/0042/0063). The authors are supported by RD12/0042/0049 (RETICS) from ISCIII and PI13/00513/FEDER from ISCIII. Fundación Séneca [19245/PI/14], Instituto Murciano de Investigación Biosanitaria [IMIB16/AP/01/06]. This work was supported by the Spanish Ministry of Economy, Industry, and Competitiveness, through the Instituto de Salud Carlos III after independent peer review (research grant: PI21/00607 co-financed by the European Regional Development Fund) and group CB16/11/00385 from CIBERCV.