title: The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants.
abstract: The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i) Dose recommendations of the NOACs in different clinical scenarios; (ii) NOACs in patients with rheumatic heart disease (RHD); (iii) Monitoring anticoagulant effect of the NOACs; (iv) Overdose of NOACs; (v) Antidotes to NOACs; (vi) Treatment of hypertrophic cardiomyopathy (HCM) with AF using NOACs; (vii) NOACs dose in elderly, (viii) Switching between NOACs and vitamin K antagonists (VKA); (ix) Cardioversion or ablation in NOAC-treated patients; (x) Planned/emergency surgical interventions in patients currently on NOACs; (xi) Management of bleeding complications of NOACs; (xii) Management of acute coronary syndrome (ACS) in AF with NOACs; (xiii) Management of acute ischemic stroke while on NOACs.
authors.affiliation: Director, Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India. Electronic address: jjdalal@hotmail.com.
authors.forename: Jamshed
authors.initials: J
authors.lastname: Dalal
authors.affiliation: Hon. Consultant Haematologist, Lilavati Hospital and Research Centre, Mumbai, India.
authors.forename: Abhay
authors.initials: A
authors.lastname: Bhave
authors.affiliation: Sr Consultant Cardiologist, Apollo Hospital, Chennai, India.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oomman
authors.affiliation: Electrophysiologist, Arrhythmia Associates and Glenmark Cardiac Centre, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Vora
authors.affiliation: Director, Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Sr Consultant Interventional Cardiologist, BM Birla Heart Research Centre, Kolkata, India.
authors.forename: Dhiman
authors.initials: D
authors.lastname: Kahali
authors.affiliation: Consultant Neurologist, Jaslok Hospital, Mumbai, India.
authors.forename: Fali
authors.initials: F
authors.lastname: Poncha
authors.affiliation: Group Director, Cardiology, Kailash Group of Hospitals and Heart Institute, Noida, India.
authors.forename: D S
authors.initials: DS
authors.lastname: Gambhir
authors.affiliation: HOD, Neurology, Yashoda Hospital, Hyderabad, India.
authors.forename: Jaydip Ray
authors.initials: JR
authors.lastname: Chaudhuri
authors.affiliation: Sr Consultant and Chief Interventional Cardiologist, Sahara Hospital, Lucknow, India.
authors.forename: Nakul
authors.initials: N
authors.lastname: Sinha
authors.affiliation: Consultant Interventional Cardiologist, AMRI Hospital, Kolkata, India.
authors.forename: Saumitra
authors.initials: S
authors.lastname: Ray
authors.affiliation: Consultant and HOD-Cardiology, Manipal Hospitals, Bengaluru, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Iyengar
authors.affiliation: Consultant Interventional Cardiologist at Apollo Gleneagles Hospital, Kolkata, India.
authors.forename: Suvro
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Professor Cardiology, AIIMS, AIIM International and Executive Director and Dean Fortis Escorts Heart Institute, New Delhi, India.
authors.forename: Upendra
authors.initials: U
authors.lastname: Kaul
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications*; D006801:Humans; D007194:India; D017410:Practice Guidelines as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: AF; Apixaban; Dabigatran; Rivaroxaban; SPAF