Non vitamin K anticoagulation drugs will win the race

Atrial fibrillation (AF) is associated with major adverse cardiovascular and cerebral events, including stroke. In order to prevent stroke, oral anticoagulation (OAC) therapy is prescribed guided by risk-stratification scores, nowadays the CHA2DS2-VASc score [1]. For more than 50 years vitamin K antagonists (VKA) have had a central role in stroke prevention in patients with AF. Most important limitations of VKAs, however, include the need for frequent monitoring of the international normalised ratio (INR) and dosing changes. Despite repeated assessment of the INR and dosing changes, it remains difficult to achieve therapeutic ranges in a substantial number of patients due to drug and food interactions, poor adherence or other, yet unknown, factors [2]. Non vitamin K oral anticoagulation drugs (NOAC) are now available as an alternative to VKA [3–6]. Many AF patients who qualify for OAC treatment are candidates for these drugs. However, despite fast adoption of these new drugs in other countries, the prescription rate in the Netherlands is still lower than expected.