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Vascul Pharmacol. 2018 Jul;106:9-21. doi: 10.1016/j.vph.2018.04.001. Epub 2018 Apr 12.

State of play and future direction with NOACs: An expert consensus.

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Department of Haematological Medicine, Guy's and St Thomas' Hospitals NHS Foundation Trust, King's College, London, UK. Electronic address:
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Center of Excellence on Aging - CeSI-Met, "G. d'Annunzio" University, Chieti, Italy.
Antwerp University Hospital, Antwerp University, Antwerp, Belgium.
University Hospital Ramo'n y Cajal, Madrid, Spain.
Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Imperial College, St George's University of London, London, UK.


Atrial fibrillation (AF) and venous thromboembolism (VTE) are cardiovascular conditions significant in contemporary practice. In both, the use of anticoagulation with vitamin K antagonists (VKAs) has been traditionally used to prevent adverse events. However, VKA therapy is associated with challenges relating to dose maintenance, the need to monitor anticoagulation, and bleeding risks. The non-vitamin K oral anticoagulants (NOACs) are becoming accepted as a clear alternative to VKA therapy for both AF and VTE management. The aim of this paper was to review contemporary evidence on the safety of NOACs in both conditions. A comprehensive literature review was conducted to explore key safety issues and expert consensus was achieved from eight professionals specialised in AF and VTE care. Consensus-based statements were formulated where available evidence was weak or contradictory. The expert statements in this paper form a key overview of the safety of NOACs compared with VKA therapy, and the comparative safety of different NOACs. It is apparent that a detailed patient work-up is required in order to identify and manage individual risk factors for bleeding and thrombosis prior to NOAC therapy. Additional measures, such as dose reductions, may also be used to maintain the safety of NOACs in practice.


Atrial fibrillation; Deep vein thrombosis; Expert consensus; Oral anticoagulants; Pulmonary embolism

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