How to choose appropriate direct oral anticoagulant for patient with nonvalvular atrial fibrillation

Ann Hematol. 2016 Feb;95(3):437-49. doi: 10.1007/s00277-015-2566-x. Epub 2015 Dec 11.

Abstract

The novel oral anticoagulants or direct oral anticoagulants (DOAC) are becoming more common in clinical practice for the prevention of stroke in non-valvular atrial fibrillation (NVAF). The availability of several agents with similar efficacy and safety for stroke prevention in NVAF patients offers more selection, but at the same time requires certain knowledge to make a good choice. This comparative analysis provides an appraisal of the respective clinical trials and highlights much of what remains unknown about four FDA-approved agents: dabigatran, apixaban, rivaroxaban, and edoxaban. It details how the DOACs compare to warfarin and to one another summarizes pharmacologic and pharmacodynamic properties, and drug interactions from the stand point of practical consequences of these findings. Common misconceptions and reservations are addressed. The practical application of this data is intended to help choosing the most appropriate agent for individual NVAF patient.

Keywords: Apixaban; Dabigatran; Direct thrombin inhibitors; Factor Xa inhibitors; Nonvalvular atrial fibrillation; Rivaroxaban; Warfarin.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / epidemiology
  • Clinical Decision-Making / methods*
  • Dabigatran / administration & dosage
  • Humans
  • Pyrazoles / administration & dosage
  • Pyridines / administration & dosage
  • Pyridones / administration & dosage
  • Randomized Controlled Trials as Topic / methods
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / prevention & control
  • Thiazoles / administration & dosage
  • Warfarin / administration & dosage
  • beta-Alanine / administration & dosage

Substances

  • Anticoagulants
  • Pyrazoles
  • Pyridines
  • Pyridones
  • Thiazoles
  • beta-Alanine
  • apixaban
  • Warfarin
  • Dabigatran
  • edoxaban