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The Figure summarizes the critical decision points with the fact that medical practice can now provide the crucial anticoagulation prophylaxis that the previous Figures have shown to be so important with agents that are as effective, or more so, than the long established agent warfarin, but with much better ease-of-use and in some cases safety and efficacy profiles. So the decision point comes down to this:
If you were a patient with AFib plus high-risk markers for stroke and embolism, which would you prefer: a stroke, a CNS bleed, or a non-CNS, nonfatal bleed?
NOACs offer the best chance of reducing the risk for stroke or systemic embolism coupled with the lowest risk for a CNS bleed or fatal bleed coupled with a lower risk for drug or food interactions and no required monitoring.
Reiffel JA. Am J Med 2013; 126: 00-00.