Table 3.

Suitability of Different Groups of Patients With Atrial Fibrillation for Treatment With Novel Oral Anticoagulants

Patient Group	Suitability for Novel OAC	Comments
Eligible for oral anticoagulation, unwilling or unable to take a VKA	Novel OAC should be considered.	May include patients with allergy or increased sensitivity to VKAs, or those not receiving VKA because of fear of bleeding (particularly ICH).
Eligible for oral anticoagulation, naïve to VKA (newly diagnosed)	All available options, including VKAs and novel OACs, should be considered.	Factors influencing therapeutic choice should include contraindications for novel OACs (eg, creatinine clearance <15 mL/min; see Table 4) and costs (direct and indirect).
Receiving VKA with unstable INR	Novel OAC should be considered depending on reason for INR instability.	If INR is unstable because of nonadherence, novel OAC therapy may not be an improvement over VKA therapy. If INR is unstable because of drug or food/alcohol interactions, novel OAC therapy may be beneficial. If INR is frequently higher than the therapeutic range, novel OAC therapy may be beneficial to reduce the risk of ICH.
Receiving VKA with stable INR	Limited justification for novel OAC (in the absence of other factors).	Benefits of VKAs are greater in patients with good INR control. Transition between anticoagulants requires careful management. Dabigatran is associated with gastrointestinal tolerability issues.

Abbreviations: ICH, intracranial hemorrhage; INR, international normalized ratio; OAC, oral anticoagulant; VKA, vitamin K antagonist.