title: Clinical follow-up of atrial-fibrillation patients treated with novel oral anti-coagulants: A multi-disciplinary consensus from the Apulia section of the Italian Association of Hospital Cardiologists (ANMCO).
abstract: The clinical use of novel oral anti-coagulant (NOAC) drugs is actually regulated in Italy by bureaucratic restrictions; clinical prescription of NOACs preliminarily requires an online prescription plan which should be compiled on the Italian Drug Agency website. The prescription plan has 1-year validity and clinical condition of the patient treated with NOACs should be reassessed at 1-year prescription renewal. Only few specialists are presently allowed to prescribe NOACs: cardiologists, geriatricians, neurologists, hematologists and internists; general practitioners (GPs) are not currently allowed to prescribe NOACs, although they are the most in proximity with the patient. An even more complex issue is the pertinence of clinical follow-up of patients prescribed with NOACs (control of possible interactions with any new drug, periodical assessment of renal function, management of dose assumption mistakes or drug suspension for occurring surgery before hospitalization for any planned intervention). International statements partially indicate when and how periodical laboratory and clinical follow-up should be performed, but such statements do not often comply with local regulations and do not always take in due consideration the local criticalities and prescription limitations. In May 2015, the regional section of the Italian Association of Hospital Cardiologists of Apulia (ANMCO) therefore convened local representative champions of medical professionals potentially involved in prescription of NOACs, clinical management and follow-up of patients prescribed with NOACs. A final consensus conference formulated a possible shared diagnostic and therapeutic pathway for the clinical management and follow-up of patients assuming NOACs for atrial fibrillation.
authors.affiliation: Cardiology Department, Ospedale S. Paolo, Bari, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: Cardiology Department, Ospedale Vittorio Emanuele II, Bisceglie, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modugno
authors.affiliation: ASL Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sportelli
authors.affiliation: Cardiology Department, Ospedali Riuniti, Foggia, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Pellegrino
authors.affiliation: Immuno-ematology Department, Ospedale Don Tonino Bello, Molfetta, Bari, Italy.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Iannone
authors.affiliation: ASL Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Zamparella
authors.affiliation: Department of Medical & Surgical Sciences, University of Foggia, Italy. Electronic address: natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Cardiology Department, Ospedale S. Paolo, Bari, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Caldarola
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003266:Continuity of Patient Care; D006801:Humans; D007558:Italy
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Consensus conference; Follow-up; Novel oral anti-coagulant