Choosing the optimal oral anticoagulant for stroke prevention in atrial fibrillation: direct oral anticoagulants vs vitamin K antagonists

Stephanie Carlin; Noel Chan; Alejandro Godoy; Vinai Bhagirath; Jack Hirsh; John Eikelboom

doi:10.1016/j.jtha.2024.11.005

Choosing the optimal oral anticoagulant for stroke prevention in atrial fibrillation: direct oral anticoagulants vs vitamin K antagonists

J Thromb Haemost. 2024 Nov 23:S1538-7836(24)00695-0. doi: 10.1016/j.jtha.2024.11.005. Online ahead of print.

Authors

Stephanie Carlin¹, Noel Chan², Alejandro Godoy³, Vinai Bhagirath², Jack Hirsh⁴, John Eikelboom³

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada. Electronic address: [email protected].
² Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

PMID: 39581233
DOI: 10.1016/j.jtha.2024.11.005

Abstract

Direct oral anticoagulants (DOACs) have replaced vitamin K antagonists (VKAs) for stroke prevention in many patients with atrial fibrillation, but VKAs may still be preferred in some situations. We use a case-based approach to present the evidence for the possible use of a VKA in preference to a DOAC in patients with atrial fibrillation and rheumatic mitral stenosis, high body mass index, frailty, and breakthrough stroke despite being prescribed a DOAC.

Keywords: atrial fibrillation; coumarins; direct-acting oral anticoagulant; rheumatic heart disease; stroke.