Interpreting Findings with Non-Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation: Collective Views on Data from Seminal Studies to Present in Clinical Practice

Abstract

Clinical trials show that non-vitamin K antagonist oral anticoagulants (NOACs) have good efficacy-safety profiles relative to warfarin across a broad spectrum of patients with non-valvular atrial fibrillation (NVAF). These findings are currently being confirmed for rivaroxaban through real-world evidence, with results from these studies consistent with results from Phase III randomised controlled trials (RCTs). Of all the NOACs, rivaroxaban currently has the most extensive real-world experience across different data sources (prospective and retrospective registries, database analyses, and prospective studies). Anticoagulant-related bleeding is still a concern amongst clinicians, however awareness of patient characteristics and other factors that can increase bleeding risk can assist in the proactive and effective management of bleeding episodes. Particularly, in atrial fibrillation (AF) patients with renal impairment who have an incrementally higher risk of bleeding and stroke, administration of NOACs versus vitamin K antagonists (VKAs) is beneficial. When dosed appropriately, NOACs such as rivaroxaban are effective in patients with renal impairment and offer an alternative to warfarin, with increased efficacy and decreased risk of critical bleeding events.