Table 3.

Patient groups likely to benefit (upper part) or not to benefit (lower part) from therapy with new anticoagulants, including a switch from existing therapy with vitamin K antagonists to one of the newer substances

Patients who are likely to benefit from new anticoagulants
Patients with poor TTR (time in therapeutic range) and INR controldue to
innate/genetics for warfarin metabolism
inadequate access to monitoring, poor monitoring quality, and/or inability to self-monitor
Patients requiring medication interacting with vitamin K antagonists
Patients who have decided against anticoagulation with vitamin K antagonists despite adequate education
Patients at low risk of gastrointestinal bleeding (dabigatran) and patients without severe renal dysfunction
Patients who suffered an ischaemic stroke on warfarin with adequate INR
Patients potentially less suitable for novel anticoagulants in the early phase after market introduction
Fragile patients, especially those requiring polypharmacotherapy and with several concomitant diseases may be at increased risk of accumulating the newer oral anticoagulants or at increased risk for rare unwanted reactions
Patients with markedly decreased moderately impaired renal function (MDRD IV–V). The pharmacology suggests that patients with renal function MDRD stage II–III may be suitable for some of the factor Xa antagonists, and MDRD II–III patients showed most benefit on therapy with dabigatran in the RELY study
Patients with history of gastrointestinal bleeding
Patients with poor TTR due to non-adherence may benefit from the regular reinforcement of therapy by monitoring needed for vitamin K antagonists therapy
Patients at risk of progressing towards severe renal failure, e.g. patients with severe heart failure
Patients with coronary artery disease with a high likelihood of requiring percutaneous revascularization until more data on combination therapy (vitamin K antagonists plus dual antiplatelet therapy) are available