Novel Oral Anticoagulants for Atrial Fibrillation

Three novel oral anticoagulants (NOACS)—dabigatran etexilate, rivaroxaban, and apixaban—have been approved in many countries for stroke prevention in atrial fibrillation, because they are associated with the same or lower rates of stroke, bleeding (particularly intracranially) and death compared with warfarin; and unlike warfarin, they can be given in fixed doses without routine coagulation monitoring. The effects of NOACs compared with warfarin are consistent in almost all populations and patient subgroups studied. Pharmacoeconomic analyses indicate that the NOACs are also cost-effective in Europe and North America. The lack of an antidote to the NOACs in patients who experience major bleeding has not been associated with a worse outcome among patients treated with NOACs compared with warfarin in secondary analyses. Multiple guidelines for the management of AF now recommend the NOACs for stroke prevention among atrial fibrillation (AF) patients at risk for stroke.