title: New Oral Anticoagulants in Nonvalvular Atrial Fibrillation.
abstract: The choice of an oral anticoagulant (OAC) for patients with nonvalvular atrial fibrillation (NVAF) is a major and complex clinical decision taking into account the individual risk-benefit ratio and bearing in mind the chronicity of therapy. This review focuses on the safety and efficacy of new oral anticoagulants (NOACs) compared with conventional vitamin K antagonists (VKA) in patients with NVAF. Current data suggest that NOACs are at least as effective and safe as VKAs for most NVAF subjects. The NOACs do not mandate dietary restrictions and regular pharmacodynamic monitoring, and they seem to have lesser incidence of intracranial or fatal bleeding when compared with VKAs. However, both dabigatran 150 twice daily and rivaroxaban have a slightly higher incidence of gastrointestinal bleeding when compared with VKAs. The article will delineate the current knowledge as well as scientific gaps related to the choice and dosage of anticoagulation regimens for various NVAF subsets and will address certain common clinical scenarios requiring special considerations. The article also addresses the shortcomings of NOACs: lack of therapeutic pharmacokinetic and pharmacodynamic targets, absence of tools to assess compliance and efficacy, rigid and limited dosage options, and absence of effective and inexpensive reversal agents.
authors.affiliation: Department of Internal Medicine, Cardiology Hospitalist Team, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Fatima
authors.initials: F
authors.lastname: Urooj
authors.affiliation: Division of Cardiovascular Medicine, Guthrie Health System, Sayre, Pennsylvania.|The Commonwealth Medical College, Scranton, Pennsylvania.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Kulkarni
authors.affiliation: Division of Cardiovascular Medicine, Guthrie Health System, Sayre, Pennsylvania.|The Commonwealth Medical College, Scranton, Pennsylvania.
authors.forename: Dwight
authors.initials: D
authors.lastname: Stapleton
authors.affiliation: Division of Cardiovascular Medicine, Guthrie Health System, Sayre, Pennsylvania.|The Commonwealth Medical College, Scranton, Pennsylvania.
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Arrhythmia/all; Clinical trials; General clinical cardiology/adult; Stroke prevention