title: [Why NAO: Know How. Why and how to choose the new oral anticoagulant in cardiological clinical practice].
abstract: Although it is well recognized that warfarin dramatically reduces the risk for ischemic stroke, its use for stroke prevention in patients with atrial fibrillation is often inadequate. Even among patients with other known risk factors for stroke (e.g., high blood pressure) and no contraindications to warfarin, warfarin therapy is prescribed in less than 60% of cases. In addition, safety and efficacy of warfarin therapy depend on adequate anticoagulation effect, but time in therapeutic range is 63%. Notably, major bleeding and intracranial hemorrhage represent a feared, though infrequent, complication. Aspirin monotherapy for stroke prevention in patients with atrial fibrillation should be discouraged, as it does not provide adequate protection against stroke and is associated with a significant increase in bleeding complications. New oral anticoagulants have a favorable risk-benefit profile, resulting in significant reductions in stroke, intracranial hemorrhage and mortality, with similar rates of major bleeding compared to warfarin but increased risk for gastrointestinal bleeding. The present review describes the new oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban with a focus on the results from major randomized clinical trials and meta-analyses. It also provides practical suggestions for their use in daily clinical practice, introducing a dedicated, novel application for smartphones and tablets.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.forename: Domenico
authors.initials: D
authors.lastname: Pecora
authors.forename: Marco
authors.initials: M
authors.lastname: Ferlini
authors.forename: Francesco
authors.initials: F
authors.lastname: Gentile
authors.forename: Luigi
authors.initials: L
authors.lastname: Moschini
authors.forename: Claudio
authors.initials: C
authors.lastname: Pedrinazzi
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Ravizza
authors.forename: Michele
authors.initials: M
authors.lastname: Romano
authors.forename: Paolo
authors.initials: P
authors.lastname: Canova
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants