The Use of New Generation Oral Anticoagulants in Primary Care
Atrial fibrillation (AF) is a disorder that increases the risk of stroke and thromboembolism 5 times more compared to healthy individuals. Therefore, thromboembolism prophylaxis is very important in these patients. Vitamin K antagonist warfarin was the first choice for this purpose until the new oral anticoagulants (NOACs) such as rivaroxaban, dabigatran, and apixaban have been developed and took their place in the guidelines for emboli and stroke prophylaxis. According to recent studies, NOACs showed a lower risk of hemorrhagic stroke or intracranial hemorrhage and did not cause an evident increase in the risk of major bleeding. Meta-analysis are supporting these studies; the risks of stroke and of thromboembolism decreased more with NOACs. NOACs are safer in patients with increased risk of intracranial hemorrhage, and warfarin is more preferable in patients with increased risk of gastrointestinal hemorrhage and/or impaired renal function. In conclusion, we should prefer NOACs in patients who can not use warfarin because of INR fluctuations. For instance, NOACs are contraindicated for any other need of anticoagulation like hypercoagulability and after heart valve replacement.
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