Replacing Warfarin for Better or Worse: Patient Factors and Future Directions

In Australia, atrial fibrillation (AF) affects 1%–2% of the population, placing them at a fivefold increased risk of stroke.  This increases sharply with age.  Warfarin has been the mainstay anticoagulant for more than 70 years for prophylaxis of stroke and the management of AF. However, in recent years, novel oral anticoagulants (NOACs) have been developed, which promise more efficacy in stroke prevention, while being safer and easier to use.

Basia Diug, Dr Judy Lowthian and Professor Michael Dooley, in their recent article in the Medical Journal of Australia, focused on strategies to improve anticoagulation management in patients with AF, in light of the increasing utility of NOACs.

Dabigatran, rivaroxaban and apixaban are the first NOACS to be made available as potential alternatives for Warfarin for the prevention of stroke in patients with non-valvular AF. All three have demonstrated effectiveness in clinical trials.  The results look promising, with all three NOACs demonstrating non-inferiority to warfarin for stroke and systemic embolism prevention.  NOACs  also have the practical advantage of involving fixed dosages and not requiring international normalised ratio monitoring.