New oral anticoagulants for the prevention of thromboembolism in atrial fibrillation: from clinical evidence to appropriate use

Abstract

The large amount of data on new oral anticoagulants deriving from the RE-LY, ROCKET AF and ARISTOTLE studies, the analysis of patient subgroups and the latest guidelines on atrial fibrillation (AF) issued by the major international cardiology societies created the need for this special issue. Regulatory approval and reimbursement within the National Healthcare System of these new oral anticoagulants for patients with AF at risk of stroke are expected to progressively modify anticoagulant therapy for most patients on warfarin treatment. This evolution in the therapeutic approach to AF is primarily driven by the improved efficacy and safety profile of these novel agents that results in reduced thromboembolic and bleeding risk, in addition to their ease of administration and freedom from laboratory monitoring. When anticoagulation is indicated, it is currently suggested to replace dose-adjusted warfarin with one of the new oral anticoagulants. Although no data from comparative studies among new anticoagulants are available, the assessment of their efficacy and safety profile will help clinicians to tailor therapy to individual patients by choosing the most effective drug at the appropriate dosage. This review describes different algorithms for the use of new oral anticoagulants in everyday clinical practice, also in AF patients with concomitant renal dysfunction, with a special focus on drug interactions and bleeding risk.