Rinsho Shinkeigaku (Clinical Neurology)

Symposium 1

How to properly use warfarin and new anticoagulants

Shinichiro Uchiyama, M.D., Ph.D.1)

1)Department of Neurology, Tokyo Women's Medical University School of Medicine

Warfarin has unmet medical needs such as blood coagulation monitoring, limitation of vitamin K intake, and interaction with other drugs, while novel oral anticoagulants (NOACs) do not have such kind of unmet medical needs. Therefore, NOACs are recommended to busy patients or patients far from hospitals, or who do not want to limit vitamin K or use many other drugs concomitantly. NOACs are also recommended to patients with low time in therapeutic range (TTR). NOACs are also recommended to warfarin-naïve patients. Warfarin is recommended to patients with economical difficulty because it is much cheaper than NOACs. If needed, warfarin should be selected in patients with renal insufficiency or under hemodialysis because NOACs are contraindicated. New guidelines by the European Society of Cardiology recommend NOACs to low risk patients with CHA2DS2-VASc score 1, and also as the first line to those with CHA2DS2-VASc 2 or more. Finally, drug should be determined by patients' preference. Doctors should give adequate information helpful for patients' selection.
Full Text of this Article in Japanese PDF (860K)

(CLINICA NEUROL, 53: 994|996, 2013)
key words: atrial fibrillation, warfarin, new oral anticoagulant, stroke prevention, cerebral hemorrhage

(Received: 29-May-13)