Current clinician perspective on non-vitamin K antagonist oral anticoagulant use in challenging clinical cases
Articles > Article · 2020
Authors: Ugur Onsel Turk, Rezzan Deniz Acar, Taylan Akgun, Volkan Emren, Selcuk Kanat, EMİR KARAÇAĞLAR, ALPER KEPEZ, ŞEREF KUL, Erdem Ozel, Evrim ŞİMŞEK, Selcen Yakar Tuluce, Kamil Tuluce, A. John Camm
TURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGY, Journal Indexed in SCI Expanded, International, 2020, vol 48, pp 289-303
Summary
Objective: The evolution of non-vitamin K antagonist anticoagulants (NOACs) has changed the horizon of stroke prevention in atrial fibrillation (SPAF). All 4 NOACs have been tested against dose-adjusted warfarin in well-designed, pivotal, phase III, randomized, controlled trials (RCTs) and were approved by regulatory authorities for an SPAF indication. However, as traditional RCTs, these trials have important weaknesses, largely related to their complex structure and patient participation, which was limited by strict inclusion and extensive exclusion criteria. In the real world, however, clinicians are often faced with complex, multimorbid patients who are underrepresented in these RCTs. This article is based on a meeting report authored by 12 scientists studying atrial fibrillation (AF) in diverse ways who discussed the management of challenging AF cases that are underrepresented in pivotal NOAC trials.