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Selecting an oral anticoagulant for patients with nonvalvular atrial fibrillation

Journal of Thrombosis and Thrombolysis volume 39, pages 129–138 (2015)Cite this article

Abstract

While the use of warfarin has been the cornerstone of thromboembolism prevention in patients with atrial fibrillation (AF), its limitations have led to the introduction of a new generation of direct-acting oral anticoagulants. Evidence from large phase III clinical trials, observational studies and pharmacokinetic analyses can guide clinicians to select the most effective and safest form of anticoagulation for patients with nonvalvular AF. This manuscript describes the main pharmacologic, clinical and epidemiological characteristics of each new oral anticoagulant and their use in selected clinical scenarios, including patients with: advanced age; at low or high risk of stroke; potential drug–drug interactions; on concomitant antiplatelet therapy; at high risk for acute coronary syndrome; with recent gastrointestinal bleeding; with renal impairment; and with hepatic dysfunction.

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Conflict of interests

Dr. Gonzalez Quesada reports no conflict of interests. Dr. Giugliano reports receiving consulting fees from Daiichi Sankyo, Janssen Pharmaceuticals, Merck, and Portola; lecture fees from Bristol-Myers Squibb, Daiichi Sankyo, Merck, and Sanofi; and Grant support through his institution from Daiichi Sankyo, Merck, Johnson & Johnson, Sanofi, and AstraZeneca.

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Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Carlos J. Gonzalez Quesada

  2. Division of Cardiovascular Medicine, TIMI Study Group, Brigham and Women’s Hospital, 350 Longwood Ave. 1st Floor Offices, Boston, MA, 02115, USA

    Robert P. Giugliano

Authors
  1. Carlos J. Gonzalez Quesada
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  2. Robert P. Giugliano
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Correspondence to Robert P. Giugliano.

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Gonzalez Quesada, C.J., Giugliano, R.P. Selecting an oral anticoagulant for patients with nonvalvular atrial fibrillation. J Thromb Thrombolysis 39, 129–138 (2015). https://doi.org/10.1007/s11239-014-1148-4

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  • DOI: https://doi.org/10.1007/s11239-014-1148-4

Keywords

  • Atrial fibrillation
  • Dabigatran
  • Apixaban
  • Rivaroxaban
  • Edoxaban
  • Warfarin