Choice of NOACs for stroke prevention in AF according to patient characteristics or preference
| Patient characteristics . | Considerations . | Drug choices . |
|---|---|---|
| Older patients | Consider anticoagulants with the lowest risk of major bleeding and the most convenience | NOACs preferred over VKAs |
| Apixaban, dabigatran 110 mg, and edoxaban are associated with lower rates of major bleeding than warfarin | ||
| High risk of bleeding | Consider anticoagulants with lowest risk of major bleeding | Apixaban, dabigatran 110 mg, or edoxaban. |
| Previous GI bleeding | Consider anticoagulants with lowest risk of GI bleeding | Apixaban or edoxaban |
| Severe renal impairment | Consider anticoagulants with the least renal clearance | Apixaban > rivaroxaban > edoxaban |
| Dyspepsia or GERD | Consider agent less likely to cause GI side effects | Apixaban, rivaroxaban, or edoxaban |
| Feeding via nasogastric or PEG tube | Consider anticoagulants with pharmacokinetic data suggesting bioequivalence between oral and enteral administration* | Apixaban or rivaroxaban |
| Nonadherence to twice-daily regimens or request to minimize pill burden | Consider anticoagulant with once-daily dosing regimen | Rivaroxaban or edoxaban |
| Patient characteristics . | Considerations . | Drug choices . |
|---|---|---|
| Older patients | Consider anticoagulants with the lowest risk of major bleeding and the most convenience | NOACs preferred over VKAs |
| Apixaban, dabigatran 110 mg, and edoxaban are associated with lower rates of major bleeding than warfarin | ||
| High risk of bleeding | Consider anticoagulants with lowest risk of major bleeding | Apixaban, dabigatran 110 mg, or edoxaban. |
| Previous GI bleeding | Consider anticoagulants with lowest risk of GI bleeding | Apixaban or edoxaban |
| Severe renal impairment | Consider anticoagulants with the least renal clearance | Apixaban > rivaroxaban > edoxaban |
| Dyspepsia or GERD | Consider agent less likely to cause GI side effects | Apixaban, rivaroxaban, or edoxaban |
| Feeding via nasogastric or PEG tube | Consider anticoagulants with pharmacokinetic data suggesting bioequivalence between oral and enteral administration* | Apixaban or rivaroxaban |
| Nonadherence to twice-daily regimens or request to minimize pill burden | Consider anticoagulant with once-daily dosing regimen | Rivaroxaban or edoxaban |
GERD, gastroesophageal reflux disorder; PEG, percutaneous endoscopic gastrostomy.
Data are available for apixaban and rivaroxaban, but not edoxaban.66 For dabigatran, the manufacturer strictly recommends against altering the capsule for administration because of substantial change in bioavailability.