Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation: Update and Periprocedural Management

Area of Science:

• Cardiology
• Pharmacology
• Nursing Education

Background:

• Vitamin K antagonists (VKAs), such as warfarin, have been the traditional standard for stroke prophylaxis in atrial fibrillation (AF).
• Direct oral anticoagulants (DOACs) represent a newer class of anticoagulants with demonstrated efficacy and safety profiles.

Purpose of the Study:

• To review and update critical care and advanced practice nurses on direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF).
• To highlight the differences between DOACs and VKAs, focusing on prescribing, adherence, interactions, and periprocedural management.

Main Methods:

• Review of current national guidelines on anticoagulation for atrial fibrillation.
• Comparative analysis of DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) versus warfarin.
• Synthesis of information relevant to nursing practice.

Main Results:

• DOACs are as efficacious as, and sometimes superior to, VKAs in preventing stroke and systemic embolism in NVAF.
• DOACs offer advantages including rapid onset, fixed dosing, no routine monitoring, short half-life, and less need for bridging therapy.
• Significant differences exist among DOACs, necessitating tailored patient management.

Conclusions:

• DOACs are a vital therapeutic option for stroke prevention in AF, offering significant benefits over VKAs.
• Understanding DOAC-specific characteristics is crucial for nurses to ensure safe and effective prescribing, adherence, and management.
• This review provides essential updates for nurses managing patients on DOACs based on the latest guidelines.