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Perspective

How should we be using nonvitamin K antagonist oral anticoagulants?

Bharat Khialani, John Amerena

Figures

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© wildpixel/istockphoto.com

Abstract

In future, nonvitamin K antagonist oral anticoagulants should be the predominant therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). The recommended parameters for prescribing represent a shift towards considering which patients with NVAF do not require anticoagulation, rather than focusing on those who do.

Key Points

  • Atrial fibrillation is a common cardiac arrhythmia, and the most common cause of stroke in the elderly.
  • Current US and European guidelines recommend the use of nonvitamin K antagonist oral anticoagulants (NOACs) over warfarin or aspirin for patients with nonvalvular atrial fibrillation (NVAF) who require anticoagulation for stroke prevention.
  • Risk scores such as the CHA2DS2-VASc and HAS-BLED scores have been developed to guide appropriate anticoagulation in patients with NVAF.
  • NOACs have been rigorously studied in clinical trials and the real world and have been shown to be safer and/or more efficacious than warfarin.
  • The inability to reverse anticoagulation with NOACs has been a concern in clinical practice, but reversal agents are now becoming available.

Figures

© wildpixel/istockphoto.com
© wildpixel/istockphoto.com