Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/26233
Title: The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation
Authors: Steffel, Jan
Verhamme, Peter
Potpara, Tatjana S.
Albaladejo, Pierre
Antz, Matthias
DESTEGHE, Lien 
Haeusler, Kart Georg
Oldgren, Jonas
Reinecke, Holger
Roldan-Schilling, Vanessa
Rowell, Nigel
Sinnaeve, Peter
Collins, Ronan
Camm, A. John
HEIDBUCHEL, Hein 
Issue Date: 2018
Source: EUROPEAN HEART JOURNAL, 39 (16), p. 1330-1393
Abstract: The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et at Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. 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 coordinate 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 as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug-drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of NOACs; (8) NOAC plasma level measurement rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu).
Notes: Steffel, J (reprint author), Univ Heart Ctr Zurich, Dept Cardiol, Ramistr 100, CH-8091 Zurich, Switzerland. j.steffel@gmx.ch
Document URI: http://hdl.handle.net/1942/26233
ISSN: 0195-668X
e-ISSN: 1522-9645
DOI: 10.1093/eurheartj/ehy136
ISI #: 000430725600007
Category: A1
Type: Journal Contribution
Validations: ecoom 2019
Appears in Collections:Research publications

Files in This Item:
File Description SizeFormat 
steffel 1.pdf
  Restricted Access
Published version7.32 MBAdobe PDFView/Open    Request a copy
Show full item record

SCOPUSTM   
Citations

572
checked on Sep 3, 2020

WEB OF SCIENCETM
Citations

1,306
checked on Mar 22, 2024

Page view(s)

112
checked on Aug 10, 2022

Download(s)

80
checked on Aug 10, 2022

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.