The focus of this review is to assist clinicians in their decision-making and prescribing practices.Īnticoagulants are categorised into two large subgroups: those affecting the rapidly flowing arterial systems and those affecting the more stasis-prone venous system. We therefore set out to review oral anticoagulants and AF with a specific focus on our patient population. The majority of South African (SA) patients are still deprived of this choice owing to financial constraints. The introduction of the direct-acting anticoagulants has changed the playing field by offering patients a choice, but at a price. Until recently, treatment options were very limited with the mainstay of treatment being the vitamin K antagonists (VKAs). Warfarin will remain the anticoagulant of choice until cheaper generic DOACs become available.Ītrial fibrillation (AF) is the commonest clinically significant arrhythmia and is associated with significant morbidity and mortality. There is a growing body of evidence that demonstrates the advantages of DOACs over warfarin in NVAF. Warfarin is still the preferred anticoagulant in patients with renal failure and prosthetic heart valves and is still the most cost-effective anticoagulant in the SA public sector setting. The direct-acting oral anticoagulants (DOACs) are superior to warfarin, with dabigatran being the preferred treatment option in patients with non-valvular atrial fibrillation (NVAF). This review evaluates the current literature on available oral anticoagulants and atrial fibrillation with specific relevance to the South African (SA) public healthcare sector, focusing on the pharmacology and monitoring of anticoagulants, current guidelines, initiation of treatment and risk stratification, effectiveness of treatment, cost-effectiveness and specific costing implications. IIMB ChB, FCFP, MFamMed, MSc (Sports Medicine), PhD Discipline of Family Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa IMB ChB Discipline of Family Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Oral anticoagulants and atrial fibrillation: A South African perspective
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