[When to replace the vitamin K antagonists by new anticoagulants?]

New oral anticoagulants (dabigatran, rivaroxaban, apixaban) have as main advantage an easier use (fixed dose therapy, no laboratory monitoring). Switching from vitamine K antagonists (VKA) to new oral anticoagulant is tempting. The indication of dabigatran and rivaroxaban for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation, and the indication of rivaroxaban for the treatment of deep-vein thrombosis and for the long-term prevention of venous thromboembolism are based from large, randomized trials. New oral anticoagulant should not be used to prevent stroke or major thromboembolic events in patients with mechanical prosthetic heart valve. It is recommended switching from VKA to new oral anticoagulant only if it is difficult to maintain a therapeutic INR Non-adherence to VKA therapy should not justify the switch to a new oral anticoagulant.