The value of novel oral anticoagulants in rural Australia

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