REVIEW ARTICLE Non-Vitamin K Antagonist Oral Anticoagulants: New Choices for Patient Management in Atrial Fibrillation

The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Atrial fibrillation (AF) is a significant problem for the aging population and remains a major factor under-lying stroke risk. Warfarin anticoagulation has been proven effective for stroke prevention in AF, but can be difficult to manage and requires frequent monitoring. The non-vitamin K antagonist oral anticoagulants (NOACs) have been shown to be as effective as warfarin for stroke prevention in non-valvular AF (NVAF) and are associated with a reduced risk of bleeding compared with warfarin. Dabigatran, ri-varoxaban, apixaban, and edoxaban have been approved in the USA for reducing the risk of stroke in patients with NVAF. In this article, AF risk assessment is discussed and NOAC phase III clinical trials for the prevention of stroke and systemic embolic events are reviewed. Further, differ-ences in stroke and bleeding outcomes between NOACs are highlighted, the use of NOACs for cardioversion and special patient populations is discussed, and management consid-erations for patients with AF are reviewed. Key Points Non-vitamin K oral anticoagulants (NOACs) are as effective as warfarin for stroke prevention in atrial fibrillation and are associated with less intracranial bleeding. NOACs may provide a simpler, safer alternative to warfarin.