Comparative Effectiveness of Different Anticoagulants in Patients with Atrial Fibrillation: A Real-World Evidence Study

Abstract

Atrial fibrillation (AF) is one of the leading causes of stroke worldwide, making effective anticoagulation essential for prevention. This retrospective, single-center study examined the outcomes of 12 adult patients with non-valvular AF admitted to a tertiary-care hospital in Pakistan, each started on either warfarin, unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or a direct oral anticoagulant (DOAC). The main focus was on in-hospital ischemic stroke or systemic embolism, with additional tracking of major bleeding, intracranial hemorrhage (ICH), AF-related readmission, and all-cause mortality. Patients given warfarin or UFH generally had higher stroke and bleeding risk scores and more chronic kidney disease, suggesting these medicines were used for those at greater baseline risk. Two strokes occurred—one in the warfarin group and one in the UFH group. A single warfarin patient suffered an ICH, which was fatal. No strokes, major bleeds, or deaths occurred among patients receiving LMWH or DOACs. One LMWH patient was readmitted with AF. The absence of adverse events in the DOAC group reflects their safety and effectiveness reported in larger studies. These findings reinforce current recommendations to prefer DOACs for eligible AF patients, while showing how clinical decisions often reflect individual patient risk.

Keywords: Atrial Fibrillation, Anticoagulants, DOACs, Warfarin, Stroke Prevention, Bleeding Risk, Pakistan, Real-World Study

https://doi.org/10.5281/zenodo.16885850