Choosing Non-Vitamin K Antagonist Oral Anticoagulants: Practical Considerations We Need to Know

摘要: Background: Warfarin is a well-established agent for use in the prevention of stroke or systemic embolic event (SEE) patients with nonvalvular atrial fibrillation (NVAF) and treatment venous thromboembolism (VTE). However, management requiring oral anticoagulation warfarin can be complicated by need frequent monitoring, drug-drug drug-food interactions, variable response based on genetic polymorphisms. The non–vitamin K antagonist anticoagulants (NOACs) were developed as alternatives to warfarin; they do not require routine monitoring have predictable pharmacokinetics, fewer limited interactions. Four NOACs—dabigatran, rivaroxaban, apixaban, edoxaban—have received approval from US Food Drug Administration SEE NVAF VTE. Selecting most appropriate each patient should done consideration preferences characteristics, including renal function, bleeding risk, other medications. Methods: A search was performed terms individual dabigatran, edoxaban, rivaroxaban identify relevant manuscripts; large randomized clinical trials, metaanalyses, guideline recommendations given preference. Searches registries, guidelines, metaanalyses specific subgroups also used. Results: NOACs are effective reducing risk associated incidents intracranial vs warfarin. Conclusion: provide convenient safe alternative may result improved therapeutic outcomes indications populations under investigation, trials investigating their acute coronary syndrome, medically ill patients, percutaneous intervention, cardioversion, catheter ablation, arterial disease, heart failure been announced.