You are reviewing the medication profile of Mrs HH, a 76-year-old woman with a history of atrial fibrillation and hypertension. Her renal and hepatic function are normal. She is currently taking enalapril 20 mg/ hydrochlorothiazide 6 mg once daily, metoprolol 50 mg twice daily and aspirin 100 mg once daily. You notice she has risk factors for stroke (age and hypertension), no apparent risk factors for bleeding apart from her age and use of aspirin (hypertension is we/I-controlled), so you decide to recommend her GP consider prescribing an anticoagulant. You are aware that, in addition to warfarin, several new anticoagulant medicines are available. Which anticoagulant would you recommend?

After reading this article, pharmacists should be able to:

• Describe the mechanism of action of novel anticoagulants (NOACs)
• Outline and compare the characteristics of NOACs
• Discuss how NOACs differ with respect to effectiveness, precautions, contraindications and adverse effect profies.