Safety and effectiveness of Rivaroxaban, Dabigatran and Apixaban in patients with non-valvular atrial fibrillation for stroke prophylaxis

Background: Atrial fibrillation is the most common arrhythmia that causes an increased risk of thromboembolism. We aimed to evaluate stroke and major bleeding risk in patients with atrial fibrillation using rivaroxaban, apixaban, dabigatran and the effects of using antiplatelet, atorvastatin and proton pump inhibitor (PPI) on development of stroke. Methods: Patients who were administered rivaroxaban, dabigatran or apixaban for atrial fibrillation between June 2014 and December 2020 were retrospectively analysed. Demographic data, CHADS2 and CHA2DS2-VASc scores, HAS-BLED scores, antiplatelet, proton pump inhibitor, atorvastatin medications were evaluated. Furthermore, we evaluated the risk of major bleeding and stroke during treatment. Results: We investigated 162 patients using dabigatran, 255 patients using rivaroxaban and 104 patients using apixaban. No significant difference was observed between the groups in terms of CHA2DS2-VASc scores and the use of atorvastatin, proton pump inhibitor and antiplatelet. HAS-BLED scores before DOACs treatment were statistically significantly higher in the apixaban group compared to rivaroxaban and dabigatran groups (p = 0.038); we found no difference between the study groups in terms of major bleeding (p = 0.528) and stroke risk (p = 0.498). The use of antiplatelet, proton pump inhibitor and atorvastatin did not have a significant effect on stroke risk (p = 0.533, p = 0.169 and p = 0.949). Conclusion: Rivaroxaban, dabigatran and apixaban have similar safety and efficacy for stroke prophylaxis. The use of antiplatelet, proton pump inhibitor and atorvastatin did not have a significant effect on stroke risk. © The Author(s) 2025.