Comparing the Efficacy and Safety of Different DOACs (Dabigatran, Rivaroxaban, Apixaban, Edoxaban) for Stroke Prevention in Atrial Fibrillation

Atrial fibrillation (AF) is a major risk factor for ischemic stroke, necessitating effective anticoagulation therapy. Direct oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, have revolutionized stroke prevention by offering comparable or superior efficacy to warfarin with improved safety profiles and fewer monitoring requirements. However, differences in efficacy, bleeding risks, and patient-specific considerations make choosing the optimal DOAC complex.This systematic review evaluates and compares the efficacy and safety of the four major DOACs for stroke prevention in AF patients. A comprehensive literature search was conducted across multiple databases to identify relevant randomized controlled trials (RCTs) and observational studies. Key outcomes assessed include stroke prevention, major bleeding events, intracranial hemorrhage, and gastrointestinal bleeding. Additionally, subgroup analyses based on renal function, age, and prior bleeding risk were explored to determine the most suitable DOAC for different patient populations. Findings indicate that while all DOACs significantly reduce stroke incidence compared to warfarin, they exhibit varying safety profiles. Apixaban demonstrates the lowest major bleeding risk, making it particularly beneficial for elderly patients or those at high bleeding risk. Dabigatran, while highly effective in stroke prevention, is associated with increased gastrointestinal bleeding. Rivaroxaban and edoxaban offer non-inferior stroke prevention but require careful dose adjustments in patients with renal impairment. Given the increasing global burden of AF, optimizing anticoagulation therapy is critical in reducing stroke-related morbidity and mortality. This review highlights the importance of individualized DOAC selection based on patient-specific factors, ensuring optimal balance between efficacy and safety. Further research into long-term adherence, real-world effectiveness, and direct head-to-head comparisons of DOACs will help refine clinical guidelines and improve patient outcomes.