Guest Editorial A Brave New World for Non-vitamin K Antagonist Oral Anticoagulants: Have We seen the Last of Warfarin?

Abstract

The use of non-vitamin K antagonist oral anticoagulants (NVKA) for antithrombotic treatment has freed patients with atrial fibrillation (AF) from the inconvenience and expense of international normalized ratio measurements. However, in the presence of coronary artery disease requiring percutaneous coronary intervention (PCI) the physician is challenged with decisions regarding which antiplatelet regimen to administer. The open-label, randomized, controlled, multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects With AF Who Undergo PCI (PIONEER AF-PCI) was the first randomized clinical trial to test safety and efficacy of a NVKA in patients with AF treated with PCI. At 1-year follow-up both dual and triple therapy with rivaroxaban were superior to triple therapy with warfarin in reducing the frequency of bleeding events. Findings from the PIONEER AF-PCI study indicate superiority of dual or triple therapy with rivaroxaban over warfarin.