The new oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: once or twice daily?

Abstract:

Atrial fibrillation significantly increases the risk of ischemic stroke. Anticoagulant therapy is the only therapeutic measure that improves prognosis and decreases mortality and morbidity in patients with atrial fibrillation. Novel oral anticoagulants (NOACs) have proven to be at least as effective as vitamin K antagonists, but with a better safety profile in terms of fatal and intracranial hemorrhages. Although there are certain pharmacological congruencies among NOACs, different NOACs have different dosing regimens which cannot be explained purely by their pharmacological characteristics. In patients with atrial fibrillation, the dosing regimen for dabigatran is twice daily, rivaroxaban once daily, and the efficacy and safety of these dosing regimens has been confirmed in the phase III clinical trials. Independent study has shown that the dosing regimen of rivaroxaban, once daily, results in better compliance and higher medication persistence compared to the dosing regimen of drugs taken twice daily, which could additionally decrease the risk of thromboembolic events in these patients. 

Key words:
anticoagulant therapy; atrial fibrillation; dosing regimen; rivaroxaban