Patients with stable, therapeutic INR values should remain on warfarin

The second decade of the 21st century will be remembered as a significant milestone in the treatment and prevention of thromboembolic diseases. The approval of target-specific oral anticoagulants (TSOACs) means that patients with atrial fibrillation (AF) have, for the first time ever, multiple treatment options for the prevention of embolic stroke. Evidence from the landmark registration trials convincingly shows that the TSOACs are at least as safe and effective as warfarin in this setting. Because the new agents do not require routine coagulation monitoring and have very few drug or dietary interactions, they offer both convenience and, possibly, a public health benefit if they are used by patients who otherwise would have declined to take warfarin. However, patients on a highly stable, therapeutic dose of warfarin should not expect better health outcomes if switching to a TSOAC.