Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation

摘要: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and a growing health problem that associated with significantly increased risk of stroke thromboembolism. Oral anticoagulant (OAC) therapy reduces all-cause mortality in patients AF. OAC commonly given as well-controlled vitamin K antagonist (VKA; e.g. warfarin) can reduce AF by almost two-thirds. However, widespread use VKAs has been hampered unpredictable pharmacokinetic pharmacodynamic properties drugs justifiable concerns about consequent haemorrhage. The non-VKA OACs (NOACs) have revolutionized thromboprophylaxis providing therapeutic options predictable are efficacious warfarin prevention thromboembolism but more convenient to use. In this review, we provide patient-centred framework assist clinicians recommending right fit individual patient AF, including methods for stratifying haemorrhage chances achieving tight control VKA anticoagulation, discuss NOACs favour their particular cohorts.