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Title: Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation
Authors: Heidbuchel, Hein 
Verhamme, Peter
Alings, Marco
Antz, Matthias
Diener, Hans-Christoph
Hacke, Werner
Oldgren, Jonas
Sinnaeve, Peter
Camm, A. John
Kirchhof, Paulus
Issue Date: 2015
Source: EUROPACE, 17 (10), p. 1467-1507
Abstract: The current manuscript is an update of the original Practical Guide, published in June 2013[Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with nonvalvular atrial fibrillation. Europace 2013; 15: 625-51; Heidbuchel H, Verhamme P, Alings M, Antz M, HackeW, Oldgren J, et al. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013; 34: 2094-106]. Non-vitamin K antagonist 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 have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group defined what needs to be considered as 'non-valvular AF' and listed 15 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 15 topics are (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 adherence 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?; (xi) 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 onNOACs; and (xv) NOACs vs. VKAs in AF patients with a malignancy. Additional information and downloads of the text and anticoagulation cards in >16 languages can be found on an European Heart Rhythm Association web site (
Notes: [Heidbuchel, Hein] Hasselt Univ, Dept Cardiol Arrhythmol, B-3500 Hasselt, Belgium. [Heidbuchel, Hein] Jessa Hosp, Ctr Heart, B-3500 Hasselt, Belgium. [Verhamme, Peter; Sinnaeve, Peter] Univ Leuven, Dept Cardiovasc Sci, Louvain, Belgium. [Alings, Marco] Amphia Ziekenhuis, Dept Cardiol, Breda, Netherlands. [Antz, Matthias] Klinikum Oldenburg, Dept Cardiol, Oldenburg, Germany. [Diener, Hans-Christoph] Univ Duisburg Essen, Univ Hosp Essen, Dept Neurol, Essen, Germany. [Hacke, Werner] Heidelberg Univ, Dept Neurol, Heidelberg, Germany. [Oldgren, Jonas] Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden. [Oldgren, Jonas] Uppsala Univ, Dept Med Sci, Uppsala, Sweden. [Camm, A. John] St Georges Univ, Clin Cardiol, London, England. [Kirchhof, Paulus] Univ Birmingham, Ctr Cardiovasc Sci, Birmingham, W Midlands, England. [Kirchhof, Paulus] Univ Munster, Dept Cardiol & Angiol, Munster, Germany.
Keywords: atrial fibrillation; anticoagulation; stroke; bleeding; pharmacology; non-VKA oral anticoagulants; NOAC;Atrial fibrillation; Anticoagulation; Stroke; Bleeding; Pharmacology; Non-VKA oral anticoagulants; NOAC
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ISSN: 1099-5129
e-ISSN: 1532-2092
DOI: 10.1093/europace/euv309
ISI #: 000366488600002
Rights: © The Author 2015. For permissions please email:
Category: A1
Type: Journal Contribution
Validations: ecoom 2017
Appears in Collections:Research publications

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