We thank Dr Trusler for his interest in our articles,1,2 but we disagree with his claim that we “ignored some very significant facts” pertaining to a comparison of the efficacy and safety of new oral anticoagulants (NOACs) with warfarin for stroke prevention in patients with atrial fibrillation (AF).
The objective of our articles1,2 was not to compare NOACs with warfarin, which has been comprehensively reviewed elsewhere.3,4 Instead, we specifically explained the following:
[T]his review focuses on treating patients who are currently taking NOACs and does not consider the process for choosing an appropriate anticoagulant for AF or VTE [venous thromboembolism], whether an NOAC or warfarin.1
We also stated:
[Warfarin] remains a treatment option for patients with AF or VTE [venous thromboembolism] in whom excellent anticoagulation control is attainable.1
Rather than engage in a potentially protracted debate on the relative merits and drawbacks of NOACs and warfarin as anticoagulants, we urge readers to reach their own conclusions by reviewing the evidence and by considering patient values and preferences, as well as the costs, of these treatment options. We also would refer readers to clinical practice guidelines developed by the Canadian Cardiovascular Society, the American College of Chest Physicians, and the European Society of Cardiology, which endorse the use of NOACs as a first-line anticoagulant option for stroke prevention for most patients with AF based on at least comparable efficacy and safety, and less intracranial hemorrhage compared with warfarin.5–7
Footnotes
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Competing interests
None declared
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