New oral anticoagulants: How safe are they?

Abstract

Introduction of the new oral anticoagulants (NoACs) to prevent and treat thromboembolic phenomena is one of the most significant innovations in clinical practice in the past 50 years. It has been about 6 years since the first new oral anticoagulant gained approval for stroke prevention in atrial fibrillation (AF) in the United States. The new anti-coagulants (Factor Xa inhibitors and factor IIa inhibitors) have major pharmacologic advantages over vitamin K antagonists (inhibiting clotting factors II, VII, IX, and X) and a very few disadvantages. Warfarin is still the drug of choice for patients with mechanical heart valves. If the patients’ compliance is debatable NoACs will not be the drugs of choice as the off-set toxicity is high to create new clots. Cost of the NoACs is higher than warfarin but somewhat similar to low molecular weight heparin (which is administered subcutaneously). With increasing familiarity among the practitioners NoACs will establish a bigger market, and long term effects of using these drugs will be known. In this article we have compared warfarin with the commonly used new oral anticoagulants to determine whether their use is safe in Sri Lanka.