Safety as a criterion for choosing an anticoagulant to prevent strokes and thromboembolism in patients with non-valvular atrial fibrillation

The article is devoted to the safety as a criterion for choosing an anticoagulant. Apixaban has been extensively studied in patients with atrial fibrillation (AF) in both randomized and real-world data (RWD) trials. The ARISTOTLE trial showed that apixaban not only significantly reduces the risk of ischemic stroke (IS) and thromboembolism (TE), intracranial bleeding, major bleeding, but also keeps down the risk of gastrointestinal (GI) bleeding. The safety of apixaban lies in the fact that it is the only direct oral anticoagulant (DOAC) that significantly reduces all-cause death based on the results of randomized clinical trials. The results of the ARISTOTLE trial have been confirmed in RWD trials showing that apixaban is safe with regards to bleeding complications and, at the same time, effective. Apixaban has been studied extensively and is used successfully in the settings of cardioversion (CV), ablation, and percutaneous coronary intervention (PCI). The 2024 European Society of Cardiology guidelines on AF puts all DOACs in the same positions, but the doctor’s task is to choose the safest among them. There is every reason to believe (based on RCTs and RWD trials findings) that apixaban is effective and the safest of 3 DOACs available in our country. According to the 2024 ESC clinical guidelines, when prescribing DOACs physicians should not exclude patients with AF who have the highest risk of bleeding, as they are often at high risk of stroke. The role of a physician is to choose the safest among DOACs, which will certainly help to improve adherence to treatment and to achieve the greatest success in preventing IS and TE.