title: EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary.
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.
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium. hein.heidbuchel@uzleuven.be
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.forename: Peter
authors.initials: P
authors.lastname: Verhamme
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Matthias
authors.initials: M
authors.lastname: Antz
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Jonas
authors.initials: J
authors.lastname: Oldgren
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.forename: A John
authors.initials: AJ
authors.lastname: Camm
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D001780:Blood Coagulation Tests; D017115:Catheter Ablation; D003324:Coronary Artery Disease / Q000150:complications; D004347:Drug Interactions; D057915:Drug Substitution; D004554:Electric Countershock; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications; D055118:Medication Adherence; D051436:Renal Insufficiency, Chronic / Q000150:complications; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Bleeding; Pharmacology; Stroke