Oral anticoagulants and clinical decision making for stroke prevention in non-valvular atrial fibrillation for nurse practitioners

This literature review explored the question of which oral anticoagulant offers the best efficacy and safety for stroke prevention in non-valvular atrial fibrillation and how the nurse practitioner should select appropriate anticoagulation for these patients. The findings of this review demonstrate that warfarin remains a safe, effective and affordable therapy. Dabigatran, rivaroxaban and apixaban, offer an alternative for those patients that cannot tolerate warfarin, or who will benefit from their unique features, but further research is needed to address their limitations. The most appropriate therapy will depend on the individual context of each patient, and the nurse practitioner should assess all variables and discuss them with the patient before making a decision. Further research and surveillance are necessary to understand the role, use, side effects and impact of new oral anticoagulation in practice. This review offers recommendations that the nurse practitioner can apply to deliver care tailored to each patient. --Leaf ii.