Direct oral anticoagulants versus warfarin: is new always better than the old?



Burn, John and Pirmohamed, Munir ORCID: 0000-0002-7534-7266
(2018) Direct oral anticoagulants versus warfarin: is new always better than the old? OPEN HEART, 5 (1). e000712-.

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: anticoagulants, atrial fibrillation, stroke, warfarin
Depositing User: Symplectic Admin
Date Deposited: 19 Mar 2018 08:39
Last Modified: 19 Jan 2023 06:38
DOI: 10.1136/openhrt-2017-000712
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3019197