Based on the net clinical benefit, NOACs have superseded VKAs for SPAF in patients with non-valvular AF. Assessment of bleeding risk factors, primarily renal function and age, and of use of concomitant drugs is required and may reveal the need for dose adjustment. There is no single NOAC that can be recommended above the other NOACs. The choice for a particular NOAC should be based on careful consideration of pharmacological properties of each drug and patient-related clinical parameters that allow for optimised stroke prevention in patients with a low risk of bleeding, and optimal bleeding prevention in patients with high risk of bleeding. The option for repackaging into smaller ready-to-dispense quantities may be considered.
Finally, knowledge transfer on SPAF is an intrinsic part of personalised care, in which family members of this elderly patient population should be involved. ●
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