Key result
Novel oral anticoagulants are clinical alternatives to warfarin for nonvalvular atrial fibrillation that require fewer clinic visits and have fewer interactions, despite higher costs and short half-lives.
NOACs offer a convenient alternative to warfarin for nonvalvular atrial fibrillation with fewer interactions, though cost, short half-life, and lack of local antidotes remain practical considerations.
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NOAC may offer practical advantages over warfarin in select AF patients; leaves open need for local outcome data before routine adoption.
Anticoagulation therapy is effective in preventing primary and secondary thromboembolic events due to atrial fibrillation. Warfarin, which was approved by the United States in 1954, was the only long-term oral anticoagulation therapy till the approval of dabigatran in 2010, and of rivaroxaban and other direct factor Xa inhibitors from 2011, forming a group known as novel oral anticoagulants (NOAC). NOAC have fewer food and drug interactions compared to warfarin; hence, the patient will require fewer clinic visits. However, the short half-life of NOAC means that twice-a-day dosing is needed and there is higher risk of a prothrombotic state when doses are missed. Other disadvantages are the lack of long-term data on NOAC, their high cost and the current lack of locally available antidotes.
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CH How (2015) conducted a review in Nonvalvular atrial fibrillation. Novel oral anticoagulants (NOAC) vs. Warfarin was evaluated. Novel oral anticoagulants are clinical alternatives to warfarin for nonvalvular atrial fibrillation that require fewer clinic visits and have fewer interactions, despite higher costs and short half-lives.
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