[New oral anticoagulants for atrial fibrillation: a neurologist's view]

Abstract

- Recent randomized controlled trials have shown that new oral anticoagulants (dabigatran, rivaroxaban en apixaban) in patients with atrial fibrillation are equally or more effective in preventing cerebral infarction than vitamin K antagonists (VKA).- New oral anticoagulants cause significant less intracranial haemorrhages. - These results also apply to patients at high risk for complications such as those with a history of cerebral infarction, and those aged 75 years and over. It is not known whether patients in the acute phase after cerebral infarction and those with blood pressure exceeding 180/110 mmHg benefit as well.- Monitoring anticoagulation is no longer needed in patients using these new oral anticoagulants, which makes daily use easier but provides less insight into medication compliance. - There is no need to switch medication in patients who respond well to VKA. However, new oral anticoagulants should be considered in patients who have problems with VKA and who have a de novo indication for anticoagulation.- Practical issues such as interaction with other drugs, medication compliance, antagonizing, monitoring of the anticoagulation and asymptomatic deteriorating renal function should be studied further.