Introduction:
Due to various limitations of warfarin use, non-vitamin K oral anticoagulants have gradually become the first choice for the prevention of ischemic stroke. This article will comprehensively and systematically evaluate the efficacy and safety of apixaban and warfarin in the prevention of ischemic stroke, to provide an evidence-based reference for clinical diagnosis and treatment.

Material and methods:
A comprehensive search of electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and Wanfang Database, was performed, and the cut-off date for all databases was May 31, 2021. We reviewed a large number of studies on apixaban versus warfarin in the prevention of ischemic stroke. We compared the incidence of ischemic stroke, any other thromboembolic events, major bleeding, intracranial hemorrhage, and gastrointestinal hemorrhage.

Results:
From the initial search of 288 results, the final meta-analysis included 11 studies, comprising 6 retrospective cohort studies, 4 observational studies, and 1 randomized controlled trial, with a total of 240,652 patients. There was no statistically significant difference between apixaban and warfarin in incidence of ischemic stroke (OR = 0.80, 95% CI: (0.56, 1.16), p = 0.25) and thromboembolic events (OR = 0.83, 95% CI: (0.63, 1.10), p = 0.19). In the apixaban group, major bleeding (OR = 0.68, 95% CI (0.55, 0.84), p = 0.0003), intracranial hemorrhage (OR = 0.48, 95% CI (0.42, 0.56), p < 0.00001), and gastrointestinal hemorrhage (OR = 0.66, 95% CI (0.60, 0.72), p < 0.00001) were significantly lower than in the warfarin group.

Conclusions:
Apixaban has more advantages and a higher safety profile than warfarin, making it worthy of widespread use.