Anticoagulation Options for Patients with Non-Valvular Atrial Fibrillation

Abstract

Patients with atrial fibrillation are at an increased risk of stroke and systemic embolic events. Anticoagulation therapy significantly reduces such risks and is an integral part of standard of care for patients with atrial fibrillation. Increased anti-coagulation options for patients with atrial fibrillation, particularly with the introduction and increased usage of novel oral anticoagulants, has made it imperative for primary care physicians to understand the risks and benefits of newer options of anticoagulation. Primary and secondary outcome data from head-to-head trials between warfarin and newer anticoagulants have been reviewed and summarized in this article. Based on the data from four robust clinical trials; dabigatran, rivaroxaban, apixaban, and edoxaban are either non-inferior or even superior to warfarin in preventing stroke or systemic embolic events. All newer oral anticoagulants were associated with a significantly lower rate of intracranial hemorrhage compared to warfarin. Overall major bleeding was less with all newer anticoagulants but gastrointestinal bleeding was significantly less with warfarin compared to dabigatran and rivaroxaban. Better safety profile with newer anticoagulants comes with a higher cost. Choice of anticoagulant should be a shared-decision between patients and their health care providers. Lack of a specific antidote, shorter half-life compared to warfarin and lack of long-term safety data are some of the issues with newer anti-coagulants that patients should be informed about.