[Vitamin K antagonists : Is their prescription really "medical malpractice" today?]

Atrial fibrillation and venous thromboembolisms are frequent cardiovascular diseases. Until a few years ago only vitamin K antagonists (VKA) were available for oral anticoagulation as primary and secondary prevention of thrombembolic events. Currently, the non-vitamin K dependent new oral anticoagulants (NOAC) dabigatran, rivaroxaban, apixaban and edoxaban are approved for use. The approval studies, meta-analyses and data from registries provide evidence for the superiority of NOAC vs. VKA with respect to reduction of thrombembolisms and reduced bleeding complications; therefore, in the 2016 European Society of Cardiology (ESC) guidelines the use of NOAC is recommended as first line therapy for anticoagulation in atrial fibrillation (recommendation grade I/evidence level A). In patients with mechanical heart valve replacement and severe renal dysfunction VKA are still clearly indicated. This also holds true for prophylaxis of secondary thromboembolic events in tumor patients. Thus, even today therapy with VKA must not be regarded as medical malpractice, especially when a good adjustment of the international normalized ratio can be achieved; however, for many patients NOAC represent a very good alternative and lead to at least equal results with less effort for the prescribing physician and the patient.