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Right selection of oral anticoagulation for stroke prevention in atrial fibrillation

Atrial fibrillation (AF) is considered as one of the most common cardiac arrhythmias worldwide and is always associated with a significantly increased risk of stroke and thromboembolism. VKAs (Warfarin & Acenocoumarol) are highly effective in reducing the risk of stroke in patients with AF, but bleeding issues & disutility sparked the development of direct oral anticoagulants (DOACs) or NOACs (Novel oral anticoagulants). These drugs, offer the convenience of once or twice daily dosing without the need for laboratory monitoring of coagulation activity (PT/ INR) or routine dose adjustment. Various clinical trials proved their non-inferiority to warfarin (VKA) in reducing the risk of stroke or systemic embolism, and each was associated with markedly lower rates of ICH than well-adjusted warfarin. Yet there are no direct head-to-head comparative trials for the efficacy & safety of NOACs. In this review we try to provide patient centric approach to assist Indian physicians in selecting right OAC therapy for SPAF with respect to best possible evidence and recommendations available worldwide.