Are you still on warfarin? Come on, switch to DOAC./NOAC This seems to be a fashion statement among cardiologists and their patients with chronic AF. (By the way, NOAC has a new name, i.e., DOAC. NOAC stands for non-vitamin K anticoagulants. Now, N is replaced with D, direct-acting oral anticoagulants.)
NOAC does have some advantages. the major one is better patient compliance, and ease of administration as it doesn’t need routine monitoring. (One may wonder how this transforms into a real advantage? ) The drug acts in a dark invisible mode. Bleeding risks are either less, equivocal, or high. So we can’t conclude conclusively on true bleeding risk.
(We do have some cumbersome monitoring methods for NOACS)
Switching games with DOAC
A detailed review of how and when to switch is in this article Adelakun BMJ open 2023
Switching to DOACs should be based on some solid scientific principles. (Of course, we have it !) But, getting rid of INR monitoring should not be the only reason. Still, the current thought process among us is to consider DOAC whenever possible or (if not make it possible somehow). In this context, this study from Circulation September 2023 (Ref 1)helps to choose which side of the OAC-DOAC debate one should fall, especially in the elderly.
Final message
Dad, are you still using that frail iPhone 11? I feel bad, will get you an iPhone 15 Pro. Its just out in Apple stores. You know, it has dynamic island technology. Wish to gift it to you this Diwali.
Oh, thanks, but I’m fine with the oldy. I can comfortably communicate with whoever I want to.Don’t enforce me, I will stick on with warfarin, my dear son.
Reference
Dr.S.Venkatesan MD 