From monitoring to vigilance about patient adherence to new oral anticoagulants

Ambivalence envelops the European Heart Rhythm Association Practical Guide1 on the use of new oral anticoagulants (NOACs). The Guide recites the NOACs' marketing claim of ‘predictable effect without need for monitoring’, but proclaims that ‘therapy prescription with the new class of drugs requires vigilance’. ‘Monitoring’, thus renamed ‘vigilance’, draws prescribers into an array of partial measures of NOAC actions of limited value, e.g. interpretations where, to be viable, knowledge of the time since the last-taken dose is required but where approximately one-third of patient-reported data on dose-timing are substantially erroneous, even in controlled clinical trials settings.The Guide aptly emphasizes the …