The value of novel oral anticoagulants in rural Australia

Ke Xu, Noel C Chan and John W Eikelboom
Med J Aust 2018; 208 (1): . || doi: 10.5694/mja17.00592
Published online: 15 January 2018

The new agents offer important safety and convenience advantages, but need to win the confidence of clinicians and patients

For more than 60 years, vitamin K antagonists, such as warfarin, have been the only option for long term oral anticoagulation therapy. Although effective for preventing and treating thromboembolism, warfarin is underused because controlling coagulation time (as measured by the international normalised ratio [INR]) is complex, and because of concerns about the risk of bleeding.1 Even when warfarin therapy is carefully managed, the INR of some patients is frequently outside the target range. Poor warfarin therapy control is associated with an increased risk of thromboembolism and bleeding. More convenient and safer oral anticoagulants are urgently needed.2

  • 1 Population Health Research Institute, Hamilton, ON, Canada
  • 2 Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
  • 3 McMaster Clinic, Hamilton, ON, Canada


Competing interests:

No relevant disclosures.

  • 1. Bungard TJ, Ghali WA, Teo KK, et al. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 2000; 160: 41-46.
  • 2. Hirsh J. Current anticoagulant therapy — unmet clinical needs. Thromb Res 2003; 109 Suppl 1: S1-S8.
  • 3. Sterne JA, Bodalia PN, Bryden PA, et al. Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2017; 21: 1-386.
  • 4. Skaistis J, Tagami T. Risk of fatal bleeding in episodes of major bleeding with new oral anticoagulants and vitamin K antagonists: a systematic review and meta-analysis. PLoS One 2015; 10: e0137444.
  • 5. Chan NC, Eikelboom JW, Weitz JI. Evolving treatments for arterial and venous thrombosis: role of the direct oral anticoagulants. Circ Res 2016; 118: 1409-1424.
  • 6. Australian Institute of Health and Welfare. Australia’s health 2016 (AIHW Cat. No. AUS 199). Canberra: AIHW, 2016.
  • 7. Bellinge JW, Paul JJ, Walsh LS, et al. The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia. Med J Aust 2018; 208: 18-23.
  • 8. Sjögren V, Byström B, Norrving B, et al. Non-vitamin K oral anticoagulants are non-inferior for stroke prevention but cause fewer major bleedings than well-managed warfarin with time in therapeutic range 70% or higher in Sweden [abstract]. Circulation 2016; 134: A18795.
  • 9. Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med 2015; 373: 511-520.
  • 10. Connolly SJ, Milling TJ, Eikelboom JW, et al. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 2016; 375: 1131-1141.


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