Key result
Novel oral anticoagulants reduced the risk of stroke and systemic embolism by 18% (RR 0.82) compared to warfarin in patients with atrial fibrillation.
Why the study?
How are novel oral anticoagulants managed in terms of monitoring, reversal, and perioperative care in patients with atrial fibrillation?
How are novel oral anticoagulants managed in terms of monitoring, reversal, and perioperative care in patients with atrial fibrillation?
Relative Risk: 0.82 (95% CI 0.69–0.98)
p-value: p=0.03
This review summarizes the efficacy, safety, perioperative management, and reversal strategies for NOACs in patients with atrial fibrillation.
Supports NOAC preference in AF; confirms phase 3 meta-analyses but leaves perioperative and reversal guidance open for prospective study.
Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring. Both United States and European Guidelines recommend NOACs for stroke prevention in patients with atrial fibrillation. This review discusses each of the NOACs, along with their efficacy and safety data. It explores the most recent guidelines regarding their perioperative use in atrial fibrillation patients. It also discusses bleeding complications, perioperative management, and reversal agents.
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Shamoun et al. (2015) conducted a review in Atrial fibrillation. Novel oral anticoagulants (NOACs) vs. Vitamin K antagonists (warfarin) was evaluated on Stroke and systemic embolism (RR 0.82, 95% CI 0.69-0.98, p=0.03). Novel oral anticoagulants reduced the risk of stroke and systemic embolism by 18% (RR 0.82) compared to warfarin in patients with atrial fibrillation.
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