Our August 2025 QQ is a poll that asked, “What AC does your provider prescribe for non-valvular AFIB?” Here are the choices made by our 18 responders:
- Apixaban (Eliquis) 10 (56%)
- Clopidogrel (Plavix) 0
- Dabigatran (Pradaxa) 3 (16%)
- Rivaroxaban (Xarelto) 1 (6%)
- Warfarin (Coumadin) 4 (22%)
This QQ arose from discussions with my (Geo) PCP and orthopedic surgeon. For a discussion of AC therapy, click our module Managing Direct Oral Anticoagulants. You can also access a six-per-page PDF handout labeled ‘DOACs‘.
In summary, Apixaban, Rivaroxaban, and Edoxaban (not included in the quiz) are oral direct anti-Xa ACs that are used routinely in NVAF. Apixaban’s renal excretion rate is 30%, and hepatic excretion 70% whereas rivaroxaban’s excretion rates are 66% renal and 28% hepatic; thus, apixaban may be chosen for patients with renal insufficiency, whereas rivaroxaban may be used in liver disease. Many providers and their patients prefer the time-honored AC warfarin. (Note that the trademark Coumadin has been retired, though we are accustomed to using it in routine conversation.) Further, Dabigatran, FDA-approved in 2008, is a viable alternative. No one bit on the “clopidogrel” mislead, as clopidogrel is an antiplatelet antithrombotic.
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