EHRA Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary†

TLDR

New oral anticoagulants (NOACs) are an alternative to vitamin K antagonists for stroke prevention in non‑valvular atrial fibrillation, and both physicians and patients must learn to use them safely in specific clinical situations. This executive summary of a practical guide assembled by the European Heart Rhythm Association aims to help physicians use the different NOACs. The guide is accompanied by an EHRA website (www.NOACforAF.eu) that provides up‑to‑date information, links to ESC AF guidelines, a key‑message pocket booklet, print‑ready files for a universal NOAC anticoagulation card, and feedback options. Practical answers are offered for 15 clinical scenarios, including initiation, monitoring, drug interactions, switching, compliance, dosing errors, chronic kidney disease, overdose, bleeding, surgical interventions, coronary artery disease, cardioversion, acute stroke, and NOACs versus VKAs in patients with malignancy. The full text is published in EP Europace.

Abstract

New oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients will have to learn how to use these drugs effectively and safely in specific clinical situations. This text is an executive summary of a practical guide that the European Heart Rhythm Association (EHRA) has assembled to help physicians in the use of the different NOACs. The full text is being published in EP Europace. Practical answers have been formulated for 15 concrete clinical scenarios: (i) practical start-up and follow-up scheme for patients on NOACs; (ii) how to measure the anticoagulant effect of NOACs; (iii) drug–drug interactions and pharmacokinetics of NOACs; (iv) switching between anticoagulant regimens; (v) ensuring compliance of NOAC intake; (vi) how to deal with dosing errors; (vii) patients with chronic kidney disease; (viii) what to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding?; (ix) management of bleeding complications; (x) patients undergoing a planned surgical intervention or ablation; (xi) patients undergoing an urgent surgical intervention; (xii) patients with AF and coronary artery disease; (xiii) cardioversion in a NOAC-treated patient; (xiv) patients presenting with acute stroke while on NOACs; (xv) NOACs vs. VKAs in AF patients with a malignancy. Since new information is becoming available at a rapid pace, an EHRA web site with the latest updated information accompanies the guide (www.NOACforAF.eu). It also contains links to the ESC AF Guidelines, a key message pocket booklet, print-ready files for a proposed universal NOAC anticoagulation card, and feedback possibilities.