US Pharm. 2019;44(2):HS-6-HS-8.

Non–vitamin K oral anticoagulants (NOACs) are now recommended as the preferred alternative to warfarin for reducing the risk of stroke associated with atrial fibrillation (AFib), according to a focused update to the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for the Management of Patients With Atrial Fibrillation.

Traditionally, anticoagulants have been recommended to reduce the risk of stroke in patients with AFib who have an increased risk of thromboembolism and/or stroke caused by narrowed or blocked arteries.

To reduce stroke risk in appropriate AFib patients, NOACs are now the preferred recommended drug class over the conventional medication warfarin, unless patients have moderate to severe mitral stenosis or an artificial heart valve. NOACs include dabigatran, rivaroxaban, apixaban, and edoxaban.

“Patients with AFib are at increased risk of stroke, which can be devastating. A goal of treating AFib patients is to make blood less likely to form clots, which reduces the risk of stroke. New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin,” said Craig T. January, MD, PhD, co-chair of the focused update published simultaneously in Circulation, Journal of the American College of Cardiology, and Heart Rhythm.

The new guidelines also suggest that NOACs could even be used in people at lower risk of stroke than thought earlier. Although the evidence for this recommendation is not yet definitive, emerging research is starting to suggest that the benefit of taking NOACs for reducing stroke risk outweighs the risk, said January, professor of cardiovascular medicine at the University of Wisconsin in Madison.