100% of patients with AFib should be referred for oral anti-coagulation therapy and should remain on the regimen for as long as they have Afib.
There is no effective, clinically useful strategy for predicting which patients will be adherent to warfarin therapy.
Before going onto a prescription for one of the NOACs for AFib, all patients should have tried and failed a properly titrated prescription to warfarin.
The converse: when a patient is diagnosed with AFib, there is no reason not to begin an immediate prescription to a NOAC.
Before prescribing anticoagulation for acute DVT/PE, all patients should have a lead-in with LMWH.
The converse: when a patient presents with DVT or PE, there is no reason not to begin an immediate prescription to a NOAC.
For all patients, even those who have demonstrated an inability to adhere to their warfarin regimen, doctors should delay prescription of any NOAC until a proven antidote has been approved for use.
Initiation of antithrombotic therapy should be based on shared decision making, after discussion about the absolute & relative risk reductions of disease & bleeding, and the patient's values & preferences.
