title: [Consensus statement: Management of oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation].
abstract: With the introduction of edoxaban last year in Germany, four nonvitamin K antagonist oral anticoagulants are now available for stroke prevention in patients with nonvalvular atrial fibrillation. These novel oral anticoagulants (NOAC) represent an attractive new option compared to vitamin K antagonists (e.g., warfarin or phenprocoumon) due to simple use and fewer interactions with other drugs or food. Therefore, no INR monitoring and dosage adjustments are required for NOAC. The compelling clinical advantage of NOAC is the dramatic risk reduction of hemorhagic stroke and intracranial bleeding compared to current standard. In addition, total mortality is significantly reduced by 10 %. These effects are demonstrated for all four NOAC (dabigatran, rivaroxaban, apixaban and edoxaban). Therefore, current national and international guidelines recommend NOAC as the preferred option or at least as an attractive alternative compared to the former standard of vitamin K antagonists. The economic impact and reimbursement by Statutory Health Insurance (GKV) is of major importance for treatment in an outpatient setting. For apixaban and edoxaban, an additional benefit was granted by the institution of G‑BA and IQWiG in this clinical setting, whereas dabigatran and rivaroxaban were not assessed due to market entrance prior to 2011 before the AMNOG procedure was initiated. The members of this consensus paper recommend NOAC as the preferred option for patients with nonvalvular atrial fibrillation who are currently not treated with anticoagulant drugs in spite of clear indication for anticoagulation. For new patients with nonvalvular fibrillation, it should be decided on an individual basis which treatment option is adequate for the patient with their respective comorbidities.
authors: Büro Berlin, Deutsche Stiftung für chronisch Kranke, Pariser Platz 6, 10117, Berlin, Deutschland.
authors: Thomas Maria
authors: TM
authors: Helms
authors: Kardiologische Praxis und Herzkatheterlabor München, München, Deutschland.
authors: Sigmund
authors: S
authors: Silber
authors: Klinik für Kardiologie und Angiologie, MHH Hannover, Hannover, Deutschland.
authors: Andreas
authors: A
authors: Schäfer
authors: Bundeswehrkrankenhaus Berlin, Berlin, Deutschland.
authors: Florian
authors: F
authors: Masuhr
authors: Neurologische Klinik, Städt. Klinikum Ludwigshafen, Ludwigshafen, Deutschland.
authors: Frederick
authors: F
authors: Palm
authors: Vivantes Klinikum Neukölln, Neukölln, Deutschland.
authors: Harald
authors: H
authors: Darius
authors: Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
authors: Karsten
authors: K
authors: Schrör
authors: Medizinische Klinik I, Kardiologie - Sektion Rhythmologie, Universitätsklinikum Rostock AoR, Rostock, Deutschland.
authors: Dietmar
authors: D
authors: Bänsch
authors: Institut für Pharmakologie und Präventive Medizin, München, Deutschland.
authors: Peter
authors: P
authors: Bramlage
authors: Institut für Pharmakologie und Präventive Medizin, München, Deutschland.
authors: Johannes
authors: J
authors: Hankowitz
authors: Herz-, Gefäß- und Diabeteszentrum Künzelsau, Künzelsau, Deutschland.
authors: Christoph A
authors: CA
authors: Karle
authors: Center for Health Economics, Universität Hamburg, Hamburg, Deutschland.
authors: Tom
authors: T
authors: Stargardt
authors: Klinik für Kardiologie, Sana Kliniken Lübeck, Lübeck, Deutschland.
authors: Joachim
authors: J
authors: Weil
authors: Klinik für Kardiologie, Abteilung für Rhythmologie und invasive Elektrophysiologie, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland. christoph.geller@zentralklinik.de.
authors: Johann Christoph
authors: JC
authors: Geller
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002309:Cardiology / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: AMNOG procedure; Atrial fibrillation; New oral anticoagulants; Reimbursement; Vitamin K antagonist