New oral anticoagulants in patients with atrial fibrillation (4)

摘要

Although new oral anticoagulants (NOACs) showed a favourable risk-benefit profile for treatment of atrial fibrillation, it is questionable whetherthey should be recommended in unselected elderly patients in primary care. Many patients with atrial fibrillation using oral anticoagulants do not meet the eligibility criteria of trials that showed effectiveness and safety of these drugs. In a case-control study, 40% of users of vitamin K antagonists presenting with bleeding had one or more exclusion criteria for these trials. This might also apply to NOACs, especially in elderly people. Several factors, such as interactions with concomitant medication, worsening of renal function, and reduced patient compliance in daily care compared with research context might affect the blood level of NOACs. In the absence of regular monitoring of coagulation, which is routine in patients using vitamin K antagonists, any deviation beyond the therapeutic range will not be noticed. This might expose patients to inadequate protection against strokes or increased risk of harm.