Dilemmas in the use of new oral anticoagulants.

The advent of the non-vitamin K oral anticoagulants (or Non-Vitamin K oral anticoagulants (NOACs)) have revolutionized the anticoagulation landscape. Patients who require anticoagulation now have freedom from frequent hospital or clinic visits for monitoring, do not have dietary restrictions, minimal drug interactions and lesser risk of intracranial bleeding. However, there are certain clinical scenarios which present dilemmas in the use the NOACs. These include their use in atrial fibrillation (AF) patients restricted to non-valvular cases, the issue of lack of antidotes, management of cerebrovascular accidents while receiving these drugs, and the emerging conundrum of whether drug level monitoring may be necessary for these drugs.