Novel Anticoagulants in Non-Valvular Atrial Fibrillation: An Evidence- Based Analysis

Randomized controlled trials are performed with a highly selected population, with good adherence. In addition, patients with comorbidities are generally excluded and the study is conducted in a well-controlled environment. On the other hand, evidence-based practice does not occur in optimal condition. The patient population is heterogeneous and their adherence to treatment may be low. This practice represents the “real world”. However, evidence-based medicine should use the best current evidence based on systematic research in a conscious and judiciously integrated with clinical expertise [1]. This practice should be aimed at decision-making for individual care of the patient. It is also important to avoid unnecessary diagnostic procedures and treatments, improving the care of patients with rational use of resources. A recent initiative to appropriate decisionmaking is called “Choosing wisely”, which helps to reduce waste in the health system and promotes dialogue between the physician and his patient [2]. These strategies should also be applied when deciding on which anticoagulant for patients with non-valvular atrial fibrillation.