title: Personalizing oral anticoagulant treatment in patients with atrial fibrillation.
abstract: For decades, warfarin has remained the standard oral anticoagulation for stroke prevention in atrial fibrillation (AF). Three novel oral anticoagulants (NOACs) have been recently approved for stroke prevention in non-valvular AF: dabigatran, rivaroxaban and apixaban. Better pharmacological and clinical profiles make these newcomers a preferable alternative over warfarin. Current AF guidelines do not endorse NOACs over warfarin, or one NOAC over another. Indeed, choice of the anticoagulation regimen should be personalized based on the relative efficacy and safety of different agents across subgroups stratified by thrombotic and bleeding risk, as well as on other clinical factors, including anticoagulation control on warfarin, drug interactions, compliance and need for coagulation monitoring. This review appraises i) the randomized evidence on approved NOACs versus warfarin in AF across subgroups stratified by risk factors of stroke and bleeding and by the anticoagulation level reached on warfarin; and ii) clinical factors impacting on the anticoagulation regimen selection.
authors: Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. pcapranzano@gmail.com
authors: Piera
authors: P
authors: Capranzano
authors: Eligio
authors: E
authors: Miccichè
authors: Lucia
authors: L
authors: D'Urso
authors: Fiorella
authors: F
authors: Privitera
authors: Corrado
authors: C
authors: Tamburino
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants