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These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin’s shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation.
However, the management of patients taking warfarin or novel agents remains a clinical challenge.
There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation.
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Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide.
The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes.
However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential.