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ORIGINAL RESEARCH ARTICLE

Cardiovascular outcomes of non-vitamin K antagonist oral anticoagulants among patients with atrial fibrillation

Yik Ching Hung1*
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1 Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
EJMO, 026180195 https://doi.org/10.36922/EJMO026180195
Received: 28 April 2026 | Revised: 1 July 2026 | Accepted: 7 July 2026 | Published online: 15 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Non-vitamin K antagonist oral anticoagulants (NOACs) effectively reduce thromboembolic stroke risk in patients with non-valvular atrial fibrillation. Evidence suggested dabigatran may carry a higher risk of myocardial infarction (MI); however, whether NOACs differ in cardiovascular safety remains unclear.

Objectives: To compare three NOACs (dabigatran, rivaroxaban, and apixaban) on the risk of MI and sudden cardiac death.

Methods: Using a database search of the New Territories West Cluster of the Hospital Authority of Hong Kong, 1,161 patients with non-valvular atrial fibrillation taking the three NOACs before December 31, 2017 were recruited into the study. Four comparison cohorts were established among factor Xa inhibitors, dabigatran, rivaroxaban, and apixaban. Cox proportional hazard regression analyses were performed among the weighted population. The primary endpoint included a combined risk of MI and sudden cardiac death. Secondary endpoints were major adverse cardiovascular events (MACE; MI, cardiovascular death, heart failure hospitalization, and stroke), individual MACE components, and fatal bleeding.

Results: Rivaroxaban, apixaban, and factor Xa inhibitors were collectively associated with an insignificant trend of lower combined risk of MI and sudden death compared to dabigatran (hazard ratios of 0.72, 0.58, and 0.67, respectively). There were no significant differences in the comparison of rivaroxaban and apixaban.

Conclusion: Dabigatran was associated with higher but insignificant cardiovascular outcomes. Cardiovascular safety may differ among NOACs in non-valvular atrial fibrillation patients.

Keywords
Atrial fibrillation
Non-vitamin K antagonist oral anticoagulants
Myocardial infarction
Funding
None.
Conflict of interest
The author declares no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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