Anticoagulation - NOACs

Consensus guideline statements have begun to appear on the use of NOACs. In these recently published European guidelines from 2012 there are 2 main recommendations.[22] (Figure 15):

The first recommendation simply said that if a vitamin K antagonist could not be used in patients who needed anticoagulation, then obviously that one of the NOACs should be used.

The second recommendation is a little more controversial; it tried to emphasize that the evidence base is strongly suggestive that NOACs are better than vitamin K antagonists, and therefore this recommendation expresses a preference for NOACs. This preference is stated at a class IIa level of evidence. This is simply because clinical experience is still relatively small with several of these drugs. Camm J. Am J Med 2013; published on-line at http://education.amjmed.com/00000.

References

[22] Camm AJ, Lip GY, De Caterina R, et al; ESC Committee for Practice Guidelines-CPG; Document Reviewers. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012;14:1385-1413.