Evaluation of the effectiveness of with different types of anticoagulants treatment in patients with atrial fibrillation in one-year follow-up in preventing stroke and bleeding complications comparison of drugs warfarin rivaroxaban and apixaban

Evaluation of the effectiveness of with different types of anticoagulants treatment in patients with atrial fibrillation in one-year follow-up in preventing stroke and bleeding complications Identifying the best treatment option among available anticoagulants to prevent stroke and bleeding events in patients with atrial fibrillation

Clinical trial, parallel group trial with blinded, randomised outcome assessment, a phase 2 trial on 198 patients

The aim of the present study was to evaluate the effectiveness of one-year anticoagulants (rivaroxaban, apixaban and warfarin) for preventing stroke and bleeding complications in atrial fibrillation patients referred to Imam Khomeini Hospital in Ahvaz. Therapeutic effectiveness is measured by clinical examinations, coagulation tests, haemoglobin nad platelet count. This double blind clinical trial is based on the protocol in in which neither the participants nor the data analyzer knows which treatment or intervention participants are receiving until the clinical trial is over.

Exclusion criteria: 1-Patients treated with multiple oral anticoagulants 2-Taking multiple doses of the drug 3-Taking drugs with indications other than prevention of stroke and hemorrhage 4-Loss to follow-up before 1 year 5-Patients without comorbidity known to be associated with higher mortality, such as heart failure, cancer, chronic pulmonary disease Inclusion criteria: 1-Age > 18 years 2-Diagnosis of atrial fibrillation 3-Informed consent to participate in the study 4-Elevated CHA2DS2-VASc score of 2 or greater in men or 3 or greater in women

1- Rivaroxaban recipients 2- Apixaban recipients 3- Warfarin recipients

Minor and major bleeding; Ischemic stroke; Systemic embolism

Randomization will be performed using block randomization of 3 blocks in 3 groups including group A (Rivaroxaban), group B (Apixaban) and group C (Warfarin). According to the sample size, the number of these blocks is 66 (198/3). The block randomization are done by random number table at the beginning of the study and stored in a sealed envelope. After the research approval, the blocks will be taken out daily based on the patients' referrals through a person who is not in the study. Patients receive the desired drugs based on block permutation.

This is a double-blind randomized clinical trial in which neither the data analyst nor the person who is evaluating the outcomes knows which type of drugs patients are receiving until the end of the study .