Controversies regarding the new oral anticoagulants for stroke prevention in patients with atrial fibrillation

Bibhu D. Mohanty, Patrick M. Looser, Lakshmi R. Gokanapudy, Rishi Handa, Sudipta Mohanty, Sharon S. Choi, Martin E. Goldman, Valentin Fuster, Jonathan L. Halperin

Research output: Contribution to journalReview articlepeer-review

Abstract

Increasing use of the new oral anticoagulants (NOACs) - dabigatran, rivaroxaban, and apixaban - has prompted considerable discussion in the medical community even as warfarin remains the mainstay of therapy. This article raises 10 controversial issues regarding the use of NOACs for stroke prevention in patients with atrial fibrillation, and offers a review of the latest available evidence. We provide a brief overview of the mechanism and dosing of these drugs, as well as a summary of the key clinical trials that have brought them into the spotlight. Comparative considerations relative to warfarin such as NOAC safety, efficacy, bleeding risk, reversibility, drug-transitioning and use in patients well controlled on warfarin are addressed. Use in select populations such as the elderly, those with coronary disease, renal impairment, or on multiple anti-platelet drugs is also discussed. Finally, we consider such specific issues as comparative efficacy, off-label use, cost, rebound and management during events. Ultimately, the rise of the NOACs to mainstream use will depend on further data and clinical experience amongst the medical community.

Original languageEnglish (US)
Pages (from-to)190-204
Number of pages15
JournalVascular Medicine (United Kingdom)
Volume19
Issue number3
DOIs
StatePublished - Jun 2014

Keywords

  • atrial fibrillation
  • oral anticoagulants
  • stroke prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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