# The comparison of inflammation markers in patients with non-valvular atrial fibrillation using warfarin and switched to apixaban

## TL;DR

This study found that switching from Warfarin to Apixaban in patients with atrial fibrillation led to lower inflammation markers, suggesting Apixaban may have stronger anti-inflammatory effects.

## Contribution

The study provides new evidence on the anti-inflammatory potential of Apixaban compared to Warfarin in non-valvular atrial fibrillation patients.

## Key findings

- Apixaban therapy resulted in significantly higher lymphocyte levels compared to Warfarin.
- Apixaban significantly reduced neutrophils, monocytes, platelets, and systemic inflammation indices compared to Warfarin.
- The study suggests Apixaban has greater anti-inflammatory effects than Warfarin in NVAF patients.

## Abstract

To compare the changes in levels of inflammation markers in the patient with non-valvular atrial fibrillation (NVAF) who were on Warfarin and then switched to Apixaban.

The files of 149 consecutive patients, who had NVAF, who were previously using Warfarin, but for various reasons switched to Apixaban were screened retrospectively. Forty-one patients were excluded from the study. Last coagulation parameters were used for analysis. The evaluation of hemogram parameters in patients undergoing treatment with Warfarin, subsequently transitioning to Apixaban, revealed significant insights into various hematological indices. Notably, the Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, the Systemic Immune-Inflammation Index, Systemic Inflammation Response Index (SIRI), the aggregate index of systemic inflammation and Monocyte/Lymphocyte Ratio were meticulously assessed and compared between the groups.

The study involved 108 individuals with NVAF. The average lymphocyte level of the patients on Apixaban therapy was statistically significantly higher than on Warfarin therapy (p<0.001). Also, The Neutrophils (p<0.001), Monocytes (p=0.008), and Platelets (p<0.001) were significantly lower in patients treated with Apixaban compared to those on Warfarin. When the systemic inflammation indices of the patients were compared, the averages of the patients’ NLR, PLR, MLR, SII, SIRI, and AISI indices were statistically and significantly lower than time on Warfarin therapy.

Current study results suggested that Apixaban has more effective anti-inflammatory potential compared to Warfarin. The study implicates new perspectives on the anti-inflammatory effects of oral anticoagulants used in the treatment of NVAF.