title: Non-vitamin K antagonist oral anticoagulants (NOACs): clinical evidence and therapeutic considerations.
abstract: Warfarin, a vitamin K antagonist, is the most widely used oral anticoagulant in the world. It is cheap and effective, but its use is limited in many patients by unpredictable levels of anticoagulation, which increases the risk of thromboembolic or haemorrhagic complications. It also requires regular blood monitoring and dose adjustment. New classes of drugs, non-vitamin K antagonist oral anticoagulants (NOACs), are now supported as alternatives to warfarin. Three NOACs are licensed: dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, antagonists of factor Xa. NOACs do not require routine blood monitoring or dose adjustment. They have a rapid onset and offset of action and fewer food and drug interactions. Current indications include treatment and prophylaxis of venous thromboembolism and prevention of cardioembolic disease in non-valvular atrial fibrillation. Effective antidotes are lacking and some caution must be used in severe renal impairment, but favourable trial evidence has led to their widespread adoption. Research is ongoing, and an increase in their use and indications is expected in the coming years.
authors.affiliation: Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK.
authors.forename: Karan
authors.initials: K
authors.lastname: Saraf
authors.forename: Paul D
authors.initials: PD
authors.lastname: Morris
authors.affiliation: Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK Department of Cardiovascular Science, University of Sheffield, Medical School, Sheffield, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Morris
authors.affiliation: Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK Department of Cardiovascular Science, University of Sheffield, Medical School, Sheffield, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Sheridan
authors.affiliation: Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK Department of Cardiovascular Science, University of Sheffield, Medical School, Sheffield, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Storey
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran / Q000627:therapeutic use; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D006801:Humans; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control*; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: CARDIOLOGY