title: Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1.
abstract: Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.
authors: Department of Neurology, University Hospital Essen, Essen, Germany.
authors: Hans-Christoph
authors: HC
authors: Diener
authors: Icahn School of Medicine at Mount Sinai, New York, USA.
authors: James
authors: J
authors: Aisenberg
authors: Hofstra North Shore/LIJ School of Medicine, Hempstead, USA.
authors: Jack
authors: J
authors: Ansell
authors: Division of Medicine, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway.
authors: Dan
authors: D
authors: Atar
authors: Division of Rhythmology, Department of Cardiovascular Medicine, Hospital of the University Münster, Münster, Germany.
authors: Günter
authors: G
authors: Breithardt
authors: Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
authors: John
authors: J
authors: Eikelboom
authors: Cardiovascular Research Foundation, New York, NY, USA.|Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA.|Lankenau Medical Center, Wynnewood, PA, USA.
authors: Michael D
authors: MD
authors: Ezekowitz
authors: Department of Medicine, Duke University, Durham, NC, USA.
authors: Christopher B
authors: CB
authors: Granger
authors: Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA.
authors: Jonathan L
authors: JL
authors: Halperin
authors: Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany.
authors: Stefan H
authors: SH
authors: Hohnloser
authors: Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors: Elaine M
authors: EM
authors: Hylek
authors: Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK.|Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany.
authors: Paulus
authors: P
authors: Kirchhof
authors: University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors: Deirdre A
authors: DA
authors: Lane
authors: Afdeling Cardiologie, Hartcentrum OLVG, Amsterdam, The Netherlands.
authors: Freek W A
authors: FWA
authors: Verheugt
authors: Stroke Medicine, Imperial College London, London, UK.
authors: Roland
authors: R
authors: Veltkamp
authors: University of Birmingham, Birmingham, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors: Gregory Y H
authors: GYH
authors: Lip
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications*; D058406:Cardiac Resynchronization Therapy; D017115:Catheter Ablation; D000066491:Clinical Decision-Making; D000075203:Contraindications, Drug; D003324:Coronary Artery Disease / Q000150:complications; D004334:Drug Administration Schedule; D004554:Electric Countershock; D006349:Heart Valve Diseases / Q000150:complications; D006350:Heart Valve Prosthesis; D006801:Humans; D062645:Percutaneous Coronary Intervention; D058729:Peripheral Arterial Disease / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Non-valvular atrial fibrillation; Non-vitamin-K oral antagonist; Stroke prevention