The Medical Letter on Drugs and Therapeutics
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Which Oral Anticoagulant for Atrial Fibrillation?

Direct-to-consumer advertisements continue to urge patients who take warfarin (Coumadin, and others) for atrial fibrillation to ask their doctors about the benefits of one or another of the newer oral anticoagulants.

WARFARIN — In patients with nonvalvular atrial fibrillation, warfarin reduces the risk of thromboembolic stroke by about 60%.1 If necessary, vitamin K, prothrombin complex concentrate, or fresh frozen plasma can reverse its anticoagulant effect.2 Drawbacks of warfarin include unpredictability and variability in dosage requirements, dietary restrictions, interactions with many other drugs, and the need for close monitoring to keep the international normalized ratio (INR) in the therapeutic range (2-3).

DIRECT ORAL ANTICOAGULANTS — The direct thrombin inhibitor dabigatran etexilate (Pradaxa) and ... more      

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