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Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation
Author(s) -
Shields A. M.,
Lip G. Y. H.
Publication year - 2015
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12360
Subject(s) - medicine , atrial fibrillation , warfarin , vitamin k antagonist , stroke (engine) , pharmacodynamics , intensive care medicine , drug , pharmacokinetics , pharmacology , mechanical engineering , engineering
Atrial fibrillation ( AF ) is the most common cardiac arrhythmia worldwide and is a growing health problem that is associated with a significantly increased risk of stroke and thromboembolism. Oral anticoagulant ( OAC ) therapy reduces the risk of stroke and all‐cause mortality in patients with AF . OAC therapy is commonly given as a well‐controlled vitamin K antagonist ( VKA ; e.g. warfarin) and can reduce the risk of stroke in AF patients by almost two‐thirds. However, the widespread use of VKA s has been hampered by the unpredictable pharmacokinetic and pharmacodynamic properties of the drugs and justifiable concerns about the consequent risk of haemorrhage. The non‐ VKA OAC s ( NOAC s) have revolutionized thromboprophylaxis in AF by providing therapeutic options with predictable pharmacodynamic and pharmacokinetic properties that are as efficacious as warfarin in the prevention of stroke and thromboembolism but are more convenient to use. In this review, we provide a patient‐centred framework to assist clinicians in recommending the right OAC therapy to fit the individual patient with AF , including methods for stratifying the risk of stroke and haemorrhage and the chances of achieving tight control of VKA anticoagulation, and we discuss the properties of the NOAC s that favour their use in particular patient cohorts.