Table 2.

General recommendations regarding the choice between warfarin and one of the new oral anticoagulants, according to European guidelines [95].

$✓$ Patients who are stable on warfarin and whose INR values are mostly in the therapeutic range need not be switched

$✓$ Patients who are noncompliant with warfarin should not be switched to the new agents because missed doses of these shorter acting anticoagulants can be more detrimental than missed doses of warfarin

$✓$ Patients with valvular AF or mechanical heart valves, with significant hepatic dysfunction or a creatinine clearance below 30 mL/min should receive warfarin

$✓$ If one of the new oral anticoagulants is prescribed in patients with moderate renal dysfunction, rivaroxaban or apixaban seem better choices given their lower degree of renal excretion when compared to dabigatran

$✓$ As gastrointestinal bleeding seems more common with dabigatran and rivaroxaban than with warfarin, patients with a recent history of gastrointestinal bleeding and a moderate to high risk of AF-related stroke should be given apixaban or warfarin. If the latter is prescribed, more frequent INR measurements (every two weeks) should be recommended

$✓$ Dyspepsia occurs in up to 10% of patients on dabigatran, so patients with upper gastrointestinal complaints (other than bleeding) may do better on apixaban, rivaroxaban or warfarin

$✓$ In patients who have suffered an ischemic stroke on warfarin, dabigatran 150 mg twice daily may be considered

$✓$ Patients at lower risk for stroke but nonetheless with indication for oral anticoagulation are better suited for dabigatran or apixaban, as such patients were not included in the ROCKET-AF trial

$✓$ When one expects the potential need to reverse the anticoagulant effect, such as in patients scheduled for AF ablation, the lack of a specific antidote for any of the new oral anticoagulants may be of concern for some operators

Legends: AF, atrial fibrillation; ROCKET-AF trial, Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation trial.