title: Selecting an oral anticoagulant for patients with nonvalvular atrial fibrillation.
abstract: While the use of warfarin has been the cornerstone of thromboembolism prevention in patients with atrial fibrillation (AF), its limitations have led to the introduction of a new generation of direct-acting oral anticoagulants. Evidence from large phase III clinical trials, observational studies and pharmacokinetic analyses can guide clinicians to select the most effective and safest form of anticoagulation for patients with nonvalvular AF. This manuscript describes the main pharmacologic, clinical and epidemiological characteristics of each new oral anticoagulant and their use in selected clinical scenarios, including patients with: advanced age; at low or high risk of stroke; potential drug-drug interactions; on concomitant antiplatelet therapy; at high risk for acute coronary syndrome; with recent gastrointestinal bleeding; with renal impairment; and with hepatic dysfunction.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA, carlosjgquesada@mail.harvard.edu.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Gonzalez Quesada
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced / Q000517:prevention & control; D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D017326:Clinical Trials, Phase III as Topic; D004347:Drug Interactions; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D020521:Stroke / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D000925:Anticoagulants