Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation

Practical Considerations on the Choice of Agent and Dosing

Dimitrios Farmakis, Periklis Davlouros, Gregory Giamouzis, George Giannakoulas, Athanasios Pipilis, Georgios Tsivgoulis, John Parissis

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Direct or new oral anticoagulants (NOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have recently revolutionized the field of antithrombotic therapy for stroke and systemic embolism prevention in nonvalvular atrial fibrillation (NVAF). Randomized controlled trials have shown that these agents have at least comparable efficacy with vitamin K antagonists along with superior safety, at least in what concerns intracranial hemorrhage. As a result, NOACs are indicated as first-line anticoagulation therapy for NVAF patients with at least one risk factor for stroke or systemic embolism. The rapid introduction, however, of NOACs in a field dominated for decades by vitamin antagonists and the variety of agents and dosing schemes may create difficulties in decision making. In the present article, we attempt to determine a practical approach to the choice of agent and dose in different clinical scenarios by considering not only the results of seminal randomized trials and post hoc analyses but also data from real-world patient populations as well as the recently available possibility of rapid NOAC reversal.

Original languageEnglish (US)
Pages (from-to)126-132
Number of pages7
JournalCardiology (Switzerland)
Volume140
Issue number2
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

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Anticoagulants
Atrial Fibrillation
Embolism
Stroke
Antithrombins
Vitamin K
Intracranial Hemorrhages
Vitamins
Decision Making
Randomized Controlled Trials
Safety
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation : Practical Considerations on the Choice of Agent and Dosing. / Farmakis, Dimitrios; Davlouros, Periklis; Giamouzis, Gregory; Giannakoulas, George; Pipilis, Athanasios; Tsivgoulis, Georgios; Parissis, John.

In: Cardiology (Switzerland), Vol. 140, No. 2, 01.07.2018, p. 126-132.

Research output: Contribution to journalReview article

Farmakis, Dimitrios ; Davlouros, Periklis ; Giamouzis, Gregory ; Giannakoulas, George ; Pipilis, Athanasios ; Tsivgoulis, Georgios ; Parissis, John. / Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation : Practical Considerations on the Choice of Agent and Dosing. In: Cardiology (Switzerland). 2018 ; Vol. 140, No. 2. pp. 126-132.
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