This review is based on a presentation given by Professor Schulman at the RCPE Haematology Symposium on 4 November 2011.Warfarin is the most widely used oral anticoagulant and has been available for more than 65 years. The last decade has brought a host of new orally available anticoagulants with promising features to clinical trials and some have already been approved for limited indications. As patients are starting to be switched to these new agents there is a need to gain understanding of the subsets of patients that will benefit the most from the new alternatives and whether warfarin is still the best choice for some subpopulations. With this knowledge we will provide the individual patient with the drug that has the best benefit/risk ratio at the same time as we conserve drug expenditures. This review discusses the directions we could follow in such a tailored anticoagulation approach, referring to the limited evidence when available.
