The Use of Novel Oral Anticoagulants in Atrial Fibrillation

Atrial fibrillation is known to be associated with an increased risk of ischaemic stroke and systemic embolism. After stratification using various risk calculation scores, patients were traditionally prescribed anticoagulants in the form of Aspirin or the traditional Vitamin K Antagonists. The use of Warfarin has proven to reduce incidents of ischaemic stroke; however its use has several limitations. The necessity for strict anticoagulation monitoring so as to maintain the narrow therapeutic range as measured by the international normalized ratio (INR) between 2 and 3 is one of these. In clinical practice, patients are within the therapeutic range lesser than two-thirds of the time and furthermore, its use is associated with a significant risk of major bleeding. The advent of Novel oral Anticoagulants marks a new era in anticoagulant therapy. The use of direct thrombin inhibitors and Factor Xa inhibitors has documented a favorable bleeding profile while being similarly or more efficacious when compared to VKA. Early studies indicate a significant reduction in the composite of stroke or systemic embolism and lowering of all-cause mortality. In this review we discuss the evidence for the clinical benefit and safety of the novel anticoagulants versus warfarin among patients with atrial fibrillation and probationary guidelines towards their use.