Non-vitamin K oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban and edoxaban have replaced warfarin as the preferred treatment for reducing stroke risk in patients with atrial fibrillation, according to updated guidelines issued Jan. 28.

The focused update for managing AFib patients, co-authored by the American Heart Association, American College of Cardiology and Heart Rhythm Society and published simultaneously in Circulation, JACC and Heart Rhythm, cited four recent randomized controlled trials comparing NOACs to warfarin.

“There was consistent evidence of at least noninferiority for the combined endpoint of stroke or systemic embolism,” Craig T. January, MD, PhD, and colleagues wrote in the update. January co-chaired the writing committee. “When combined with a superior safety profile, they are recommended as first-line therapy for eligible patients.”

While warfarin is effective at reducing stroke risk in AFib patients, its bleeding risk rivals its efficacy, January et al. said. With the exception of patients with moderate to severe mitral stenosis or an artificial heart valve, NOACs minimize that risk. The anticoagulants might even be beneficial to patients at a lower risk for stroke than previously thought, and although the evidence for that recommendation isn’t set in stone, emerging research suggests the benefit of NOACs for these patients might outweigh the risk of not taking them.