RT Journal Article
SR Electronic
T1 Direct oral anticoagulants versus warfarin: is new always better than the old?
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000712
DO 10.1136/openhrt-2017-000712
VO 5
IS 1
A1 John Burn
A1 Munir Pirmohamed
YR 2018
UL http://openheart.bmj.com/content/5/1/e000712.abstract
AB About 1.4 British million people are at risk of strokes due to non-valvular atrial fibrillation (AF) necessitating long-term anticoagulation. The vitamin K antagonist, warfarin, has a long half-life and narrow therapeutic range necessitating regular monitoring and is a common cause of iatrogenic hospital admission. Direct-acting oral anticoagulants (DOACs), dabigatran, rivaroxaban, apixaban and edoxaban are not required to have monitoring but are sensitive to changes in renal function and are associated with poorer adherence. There are good grounds to believe that DOACs are not always superior to warfarin in routine practice particularly with an older population. Much higher levels of therapeutic effectiveness can be achieved using a simple genotype guidance to identify those who are highly sensitive and by adoption of home monitoring. These adjustments could make warfarin the preferred drug for most people and would reduce the dramatic rise in health service expenditure.