Key result
NOACs are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding in atrial fibrillation patients with difficult clinical scenarios.
This review highlights the importance of tailoring oral anticoagulant therapy for stroke prevention in atrial fibrillation patients with complex clinical presentations.
May support NOAC preference in complex AF; leaves open dedicated RCTs in rare subgroups.
Atrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X, has been recommended for stroke prevention for decades. Non-Vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding. With the increasing prevalence of AF, prescription of the appropriate oral anticoagulants (OACs) according to patient's characteristics becomes a challenge. This review article aims to provide an overview of anticoagulant use in AF patients with difficult scenarios.
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Chang et al. (2018) conducted a review in Atrial fibrillation. Non-Vitamin K antagonist oral anticoagulants (NOACs) vs. Warfarin was evaluated. NOACs are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding in atrial fibrillation patients with difficult clinical scenarios.
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