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Updated: May 10, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Adopting the new anticoagulants: all aboard or all in good time?
Marc W Deyell1, Jafna L Cox, Matthew T Bennett
1Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract:
At last there is now more than 1 oral anticoagulant (OAC) available for stroke prevention in atrial fibrillation. Though more choice is a good thing, it does mandate knowing which drug is the most appropriate in a given clinical situation. Three novel OACs--dabigatran, rivaroxaban, and apixaban--are approved for use in atrial fibrillation in Canada. They have each been evaluated in large, randomized controlled trials where they have been shown to be noninferior, or in some cases superior, to warfarin (Coumadin). Prescription coverage for these drugs is increasingly available through third party and government drug plans. The major enhancements of the novel OACs relate to their rapid, consistent anticoagulant effect at fixed dosing and the lack of need for monitoring of anticoagulant effect. Nonetheless, their use is not foolproof and practitioners must be familiar with their limitations. On balance, we favour the use of novel OACs over warfarin in patients who are anticoagulant-naive, given their increased ease of use. However, we advocate switching from warfarin only if international normalized ratio control has been poor or if frequent monitoring is problematic.
Insights
Novel oral anticoagulants (OACs) offer easier stroke prevention for atrial fibrillation patients compared to warfarin. They provide consistent effects without frequent monitoring, making them ideal for new users.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Atrial fibrillation necessitates stroke prevention.
- Warfarin has been the traditional oral anticoagulant (OAC).
- Multiple OACs are now available for clinical use.
Purpose of the Study:
- To compare novel OACs with warfarin for stroke prevention in atrial fibrillation.
- To guide the appropriate selection of OACs in clinical practice.
- To highlight the benefits and limitations of novel OACs.
Main Methods:
- Review of large, randomized controlled trials comparing novel OACs (dabigatran, rivaroxaban, apixaban) with warfarin.
- Analysis of drug efficacy, safety, dosing, and monitoring requirements.
- Evaluation of prescription coverage and accessibility.
Main Results:
- Novel OACs demonstrated non-inferior or superior efficacy to warfarin in stroke prevention.
- These agents offer rapid, consistent anticoagulant effects with fixed dosing.
- Monitoring of anticoagulant effect is not required for novel OACs.
- Prescription coverage is expanding.
Conclusions:
- Novel OACs are favored over warfarin for anticoagulant-naive patients due to ease of use.
- Switching from warfarin is recommended for patients with poor international normalized ratio control or monitoring challenges.
- Practitioners must be aware of the limitations of novel OACs.
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