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Replacing warfarin for better or worse: identifying patient factors and future directions

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Care models must consider patient factors to ensure safe and effective use of patient-administered anticoagulants

In Australia, atrial fibrillation (AF) affects 1%–2% of the population, placing them at a fivefold increased risk of stroke.1 The prevalence of AF increases sharply with age, with 50% of patients aged 75 years or over.2 Warfarin has been used clinically for more than 70 years and is the mainstay anticoagulant for prophylaxis of stroke as well as for the management of AF. However, in recent years, the novel oral anticoagulants (NOACs) dabigatran, rivaroxaban and apixaban have been developed. These promise more efficacy than warfarin in stroke prevention, while being safer and easier to use.3

A recent review by the Australian Government Department of Health and Ageing provided perspectives on current and future options for improving the use of anticoagulation therapies in managing patients with AF.2 In this article, we focus on strategies to improve anticoagulation management in patients with AF in light of the increasing utility of NOACs.

Warfarin in clinical practice

Despite the availability of oral alternative therapies, warfarin — a vitamin K antagonist — remains efficacious and cost-effective in reducing the incidence of stroke in patients…