Potential use of NOACs in developing countries: pros and cons

Area of Science:

• Cardiology
• Pharmacology
• Global Health

Background:

• Vitamin K antagonists (VKAs) are effective for atrial fibrillation (AF) thromboprophylaxis but are underutilized in developing countries.
• Novel oral anticoagulants (NOACs) present potential alternatives to VKAs.
• Introduction of NOACs in developing countries requires careful consideration of specific challenges.

Purpose of the Study:

• To review the current antithrombotic management of AF in developing countries.
• To explore early evidence for NOACs in these settings.
• To identify special considerations for NOAC implementation within developing healthcare systems.

Main Methods:

• Literature search of PubMed and Google Scholar (2000-2014).
• Keywords included AF, oral anticoagulants, VKAs, NOACs (dabigatran, rivaroxaban, apixaban, edoxaban), monitoring parameters, cost-effectiveness, and country-specific terms.
• Review of randomized trials, observational studies, case studies, and reviews.

Main Results:

• Data on AF management quality is often lacking in developing countries.
• Anticoagulant utilization for AF varies significantly across developing nations.
• While NOACs offer advantages over VKAs, current evidence is insufficient to recommend widespread warfarin replacement; VKAs may remain relevant.
• Alternative monitoring strategies for VKAs could enhance their utility.

Conclusions:

• NOAC introduction must consider safety, budget, and the existing quality of oral anticoagulation care.
• Prospective registries are crucial for evaluating the comparative safety, efficacy, and cost-effectiveness of NOACs versus VKAs in developing countries.