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Oral Anticoagulation

Ertunc Altiok1, Nikolaus Marx

  • 1Department of Cardiology, Angiology and Intensive Care Medicine (Department of Internal Medicine I), University Hospital Aachen, RWTH Aachen University, Aachen, Germany.

Deutsches Arzteblatt International
|January 4, 2019
PubMed
Abstract

Insights

Newer non-vitamin-K-dependent oral anticoagulants (NOAC) show similar efficacy and safety to vitamin K antagonists (VKA) for stroke prevention, but evidence remains limited for long-term use.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Recent advancements have introduced non-vitamin-K-dependent oral anticoagulants (NOAC) alongside traditional vitamin K antagonists (VKA).
  • This review synthesizes current evidence on oral anticoagulation therapies for diverse clinical indications.

Purpose of the Study:

  • To review and compare the evidence for vitamin K antagonists (VKA) and non-vitamin-K-dependent oral anticoagulants (NOAC) in various anticoagulation indications.
  • To highlight current guidelines and clinical practice regarding oral anticoagulation.

Main Methods:

  • A selective PubMed search was conducted for articles published between 2000 and 2018.
  • Key search terms included anticoagulation, atrial fibrillation, prosthetic valve, thrombosis, and pulmonary embolism.
  • Specialty society recommendations and relevant clinical guidelines were also incorporated.

Main Results:

  • Oral anticoagulation is primarily indicated for atrial fibrillation, venous thromboembolism, and post-heart valve replacement.
  • For atrial fibrillation without valvular heart disease, NOACs demonstrated a marginally lower stroke rate (3.5% vs. 3.8%) and major hemorrhage rate (5.1% vs. 6.2%) compared to VKAs.
  • NOACs are contraindicated in patients with mechanical heart valves, and while dabigatran has an antidote, others (apixaban, rivaroxaban, edoxaban) do not yet have specific antidotes.

Conclusions:

  • The current evidence base for long-term oral anticoagulation is insufficient.
  • Direct comparative data among different non-vitamin-K-dependent oral anticoagulants are not yet available.

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