When a patient is diagnosed as having a risk level that warrants anticoagulation therapy (as opposed merely to a simple antiplatelet prescription), the question becomes, which anticoagulation therapy? For the past several decades, this has meant warfarin therapy. Warfarin use has the benefit of more than 50 years of clinical experience; moreover warfarin is inexpensive, it has generic availability, and it has a wide range of clinical use indications beyond merely stroke prophylaxis in patients with AFib. The last 2 years have seen the introduction of the first new, novel oral anticoagulation (NOAC) agents in decades, and as shown in the Figure, these have been shown to have several advantages over use of warfarin in general medical practice. Thus these NOACs have a rapid onset of activity and a much shorter half-life; they do not require the monitoring that warfarin requires to maintain therapeutic serum levels; and they have fewer drug-drug and drug-food interactions.
The most important point about any of these agents, of course, is that none of these agents is effective if they are not used.
Rothman SA. Am J Med 2013; 126: 00-00.
