Steffel, J;
Verhamme, P;
Potpara, TS;
Albaladejo, P;
Antz, M;
Desteghe, L;
Georg Haeusler, K;
Oldgren, J;
Reinecke, H;
Roldan-Schilling, V;
et al.
Steffel, J; Verhamme, P; Potpara, TS; Albaladejo, P; Antz, M; Desteghe, L; Georg Haeusler, K; Oldgren, J; Reinecke, H; Roldan-Schilling, V; Rowell, N; Sinnaeve, P; Collins, R; Camm, AJ; Heidbüchel, H; ESC Scientific Document Group
(2018)
The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary.
Europace, 20 (8).
pp. 1231-1242.
ISSN 1532-2092
https://doi.org/10.1093/europace/euy054
SGUL Authors: Camm, Alan John
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Abstract
The current manuscript is the Executive Summary of the second update to the original Practical Guide, published in 2013. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to co-ordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are (i) eligibility for NOACs; (ii) practical start-up and follow-up scheme for patients on NOACs; (iii) ensuring adherence to prescribed oral anticoagulant intake; (iv) switching between anticoagulant regimens; (v) pharmacokinetics and drug-drug interactions of NOACs; (vi) NOACs in patients with chronic kidney or advanced liver disease; (vii) how to measure the anticoagulant effect of NOACs; (viii) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (ix) how to deal with dosing errors; (x) what to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (xi) management of bleeding under NOAC therapy; (xii) patients undergoing a planned invasive procedure, surgery or ablation; (xiii) patients requiring an urgent surgical intervention; (xiv) patients with AF and coronary artery disease; (xv) avoiding confusion with NOAC dosing across indications; (xvi) cardioversion in a NOAC-treated patient; (xvii) AF patients presenting with acute stroke while on NOACs; (xviii) NOACs in special situations; (xix) anticoagulation in AF patients with a malignancy; and (xx) optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA web site (www.NOACforAF.eu).
Item Type: | Article | ||||||||
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Additional Information: | This is a pre-copyedited, author-produced version of an article accepted for publication in Europace following peer review. The version of record Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel, ESC Scientific Document Group; The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary, EP Europace, Volume 20, Issue 8, 1 August 2018, Pages 1231–1242 is available online at: https://doi.org/10.1093/europace/euy054 Figure 2 redacted for copyright reasons. Please see the published version for this figure. | ||||||||
Keywords: | Cardiovascular System & Hematology, 1103 Clinical Sciences | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | Europace | ||||||||
ISSN: | 1532-2092 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
PubMed ID: | 29562331 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/109769 | ||||||||
Publisher's version: | https://doi.org/10.1093/europace/euy054 |
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