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Efficacy and Limitations of Warfarin and Novel Oral Anticoagulants with Atrial Fibrillation

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Book cover Left Atrial Appendage Closure

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Atrial fibrillation is common and its prevalence is directly related to age. The annual incidence of stroke or non-CNS emboli (SSE) is 4.5 % without antithrombotic therapy. Oral anticoagulant therapy (OAC) is extremely effective for the prevention of SSE, and for most patients, the risk:benefit ratio for stroke vs. major hemorrhage favors the use of OAC. A series of randomized controlled trials (RCTs) showed a 64 % reduction in the risk of stroke with warfarin compared to controls and a 39 % reduction compared to aspirin. Long-term warfarin is a challenging drug for patients to take and for physicians to prescribe and monitor. The novel oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) were developed to overcome many of the challenges posed by warfarin anticoagulation. They have each been directly compared to warfarin in a large RCT and each has been shown to be at least as effective for the prevention of SSE (dabigatran 150 mg bid and apixaban 5 mg bid are more effective) and to have no more major bleeding (dabigatran 110 mg bid, apixaban, edoxaban 30 mg and edoxaban 60 mg have less). National guidelines organizations are recommending these new agents as alternatives to warfarin and in some instances as preferable to warfarin. Although there have been no direct comparisons of one NOAC to another, there are differences in their pharmacokinetics and pharmacodynamics and it is possible that there may be differences in their efficacies and safety in relation to individual patient characteristics. The national guidelines groups have generally not made any formal recommendations for the choice of one NOAC over another.

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Authors and Affiliations

  1. GLD Health Care Centre, University of British Columbia, 2775 Laurel St., Vancouver, BC, Canada, V5Z 1M9

    John A. Cairns M.D., F.R.C.P.C., F.A.C.C.

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  1. John A. Cairns M.D., F.R.C.P.C., F.A.C.C.
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Correspondence to John A. Cairns M.D., F.R.C.P.C., F.A.C.C. .

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Editors and Affiliations

  1. Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

    Jacqueline Saw

  2. Cardiovascular Intervention Center Research, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Saibal Kar

  3. Scripps Translational Science Institute, Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA

    Matthew J. Price

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Cairns, J.A. (2016). Efficacy and Limitations of Warfarin and Novel Oral Anticoagulants with Atrial Fibrillation. In: Saw, J., Kar, S., Price, M. (eds) Left Atrial Appendage Closure. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-16280-5_2

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  • DOI: https://doi.org/10.1007/978-3-319-16280-5_2

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