Eight studies (n = 183167, 38% female) met the criteria for study inclusion. Four were randomized control trials (RCTs) and four were retrospective cohort studies. Mechanical and bioprosthetic valves were represented in 14.7% and 85.3% of patients respectively. There was no statistically significant difference between NOACs and warfarin for all bleeding, all-cause mortality, TIA, systemic embolism, and all-stroke outcomes. Overall Warfarin led to 22% more major bleeding (OR = 1.22, 95% CI = [1.05, 1.41], p = 0.01) and more ischemic stroke (OR = 1.72, 95% CI = [1.1, 2.68], p = 0.02) compared to NOACs. Also amongst patients with bioprosthetic heart valves, Warfarin led to 33% more major bleeding compared to NOACs (OR = 1.33, 95% CI = [1.06, 1.66]). However, NOACs led to 65% more major bleeding compared to warfarin among those with mechanical heart valves (OR = 0.35, 95% CI = [0.18, 0.67]).