• Among patients > 75 years and certainly those > 80 years, dose reduction of the new OACs, especially dabigatran, should be considered.
• As experience with the new OACs increases, a number of practical issues around their use will become clearer. Practical tips are provided to assist the practitioner in using new OACs where reasonable data exist to guide therapy. Further data are needed to guide bridging prior to and after surgical procedures, DC cardioversion, monitoring of anticoagulant effect, and reversal when bleeding occurs using new OACs. Likewise, advice for dose-reduction related to low body mass index and in the presence of hepatic dysfunction is needed.