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Novel oral anticoagulants in atrial fibrillation: which novel oral anticoagulant for which patient?

Prisco, Domenico; Cenci, Caterina; Silvestri, Elena; Ciucciarelli, Lucia; Di Minno, Giovanni

Journal of Cardiovascular Medicine: July 2015 - Volume 16 - Issue 7 - p 512–519
doi: 10.2459/JCM.0000000000000262
Anticoagulation: Review

Atrial fibrillation is the most common rhythm disorder and represents a major public health problem because it carries an increased risk of arterial thromboembolism and ischemic stroke. Current european society of cardiology guidelines recommend to stratify atrial fibrillation patients according to the CHA2DS2-VASc score and to administer anticoagulation, preferably with novel oral anticoagulants, that is, dabigatran, rivaroxaban, or apixaban, if the CHA2DS2-VASc score is at least 1. All novel anticoagulants have shown the same, if not greater, efficacy and safety as warfarin, with some advantages. The choice among the novel oral anticoagulants depends on their different pharmacokinetic profile, patients’ stroke and bleeding risk, comorbidities, drug tolerability and costs and, finally, patients’ preferences.

aDepartment of Experimental and Clinical Medicine, University of Florence

bSOD Patologia Medica, AOU Careggi, Florence

cDepartment of Clinical Medicine and Surgery, University of Naples ‘Federico II’, Naples, Italy

Correspondence to Caterina Cenci, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy E-mail:

Received 10 August, 2014

Revised 22 November, 2014

Accepted 7 December, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.