Figure 3. Guidance for Determining Which NOAC to Prescribe
Possible considerations (authors’ opinions) for selecting between novel oral anticoagulants (if preferred to a vitamin K antagonist) based on patient characteristics in the absence of head-to-head trials. Any clinical decision should take account of individual patient presentation and agent/dose availability based on local regulatory approval. Clinical opinions are often based on indirect comparisons, subgroup analyses, adverse event profiles, and clinical trials in other patient populations. None of these data on which a choice will be made is individually valid, and together only provide a gestalt, but in the absence of other information clinicians have no other way to proceed. Abbreviations: ACS, acute coronary syndrome; AF, atrial fibrillation; CAD, coronary artery disease; GI, gastrointestinal; HAS-BLED, hypertension, abnormal renal/liver function (1 point each), stroke, bleeding history or predisposition, labile international normalized ratio, elderly (≥65 years), drugs/alcohol concomitantly (1 point each); MI, myocardial infarction.
Reprinted from Savelieva I et al. Practical Considerations for Using Novel Oral Anticoagulants in Patients With Atrial Fibrillation. Clin Cardiol. 2013; 37: 32-47. Copyright 2013 Wiley Periodicals, Inc.