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NOACs approved by new AHA guidelines

The new oral anticoagulants (NOACs) all represent important advances over warfarin because they have more predictable pharmacological profiles, fewer drug–drug interactions, an absence of major dietary effects, and less risk of intracranial bleeding, according to the new American Heart Association guidelines.1

The authors point out that selection of agents for antithrombotic therapy depends on a large number of variables, including cost, and that the newer agents are currently considerably more expensive than warfarin. “If patients are stable, easily controlled, and satisfied with warfarin therapy, it is not necessary to change to one of the newer agents,” they say.

However, it is important to discuss the option of NOACs with patients who are candidates, they add: “They have rapid onset and offset of action such that bridging with parenteral anticoagulant therapy is not needed during initiation, and bridging may not be needed in patients on chronic therapy requiring brief interruption of anticoagulation for invasive procedures.”

They caution that strict compliance with NOACs is critical, as missing even one dose could result in a period without protection from thromboembolism. “As a result, the USA Food and Drug Administration has issued black box warnings regarding discontinuation of these newer agents that can increase the risk of thromboembolism, and coverage with another anticoagulant may be needed. In addition, reversal agents, while under development, are not presently available, although the short half-lives lessen the need for an antidote,” the authors add.

“Although dose adjustments may be warranted for those with chronic kidney disease or body weight extremes, these new agents do not require regular INR or activated partial thromboplastin time monitoring,” they conclude.


1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014;129.

Published on: April 30, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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