Despite this data, uptake has been slow and the majority of patients started on an anticoagulation for AF in the United States are still started on warfarin, largely by primary care physicians. Individually, the NOACs are at least as safe and effective as warfarin for prevention of stroke and systemic embolism in patients with AF ( 5- 8). These new agents offer additional potential advantages over vitamin K antagonists, such as rapid onset and off set of action, absence of an effect of dietary vitamin K intake on their activity, and fewer drug interactions. The predictable anticoagulant effects of the NOACs enable the administration of fixed doses without the need for routine coagulation monitoring, thereby simplifying treatment. Several novel oral anticoagulants (NOACs) have been developed that dose-dependently inhibit thrombin or activated factor X (factor Xa) ( 5- 8). Thus, a need arose for new anticoagulant agents that are effective, safe, and convenient to use. These limitations result in poor patient compliance and likely contribute to the underuse of vitamin K antagonists for stroke prevention ( 3, 4). Although these drugs are highly effective in the prevention of thromboembolism, their use is limited by the need for regular monitoring and the possibility of food and drug interactions. Until 2009, warfarin and other vitamin K antagonists were the only class of oral anticoagulants available. It is associated with significant morbidity and mortality related to stroke due to thromboembolism ( 2). Accepted for publication Dec 19, 2014.Ītrial fibrillation (AF) is the most common cardiac arrhythmia, with a lifetime risk exceeding 20% by 80 years of age ( 1). Keywords: Anticoagulants atrial fibrillation (AF) hemorrhage stroke warfarin Interviews with Outstanding Guest Editors.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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