A Practical Approach to the New Oral Anticoagulants Used for Stroke Prevention in Patients with Atrial Fibrillation

Abstract

This review evaluates the research undertaken in the last six years on the use of new oral anticoagulants for stroke prevention in atrial fibrillation and provides evidence-based answers to common clinical questions. Two types of new oral anticoagulants - direct thrombin (IIa) inhibitors, and Xa inhibitors - are currently available. These drugs have similar pharmacokinetics and pharmacodynamics. They are more predictable than, though in many respects comparable to, warfarin. They do not require frequent laboratory tests, nor do they have a narrow therapeutic window. When a patient requires surgery, new oral anticoagulants are easier to manage than warfarin due to their short half-lives. Short half-lives reduce the length of bleeding events. Information obtained from risk calculators such as CHA2DS2-VASc and HAS-BLED should be considered before prescribing. New oral anticoagulants are useful in every day clinical practice, but there are complex factors that should be considered in each patient before prescribing to implement the best practice and achieve the best results.

Personalised Approach to Anticoagulation

“…1 The new team may wish to reflect on the review in the same journal issue of the use of direct oral anticoagulants (DOACs), formally known as NOACs, as an alternative to warfarin. 2 Though well researched in terms of the details on use of DOACs, there were a number of oversights. Dabigatran, like warfarin, is susceptible to interpersonal variation, something the makers failed to make public, leading to legal actions.…”

“…We are exploring the feasibility of this 'personalised' approach in Newcastle with other centres in development. 1 J Burn, 2 H Sheth 1 Professor of Clinical Genetics, 2 Research Fellow, Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK Email john.burn@newcastle.ac.uk…”