Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary.
In 2013, the European Heart Rhythm Association (EHRA) published a Practical Guide on the use of non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) (Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, European Heart Rhythm A. 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 H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013;34:2094-2106). The document received widespread interest, not only from cardiologists but also from neurologists, geriatricians, and general practitioners, as became evident from the distribution of >350 000 copies of its pocket version (the EHRA Key Message Booklet) world-wide. Since 2013, numerous new studies have appeared on different aspects of NOAC therapy in AF patients. Therefore, EHRA updated the Practical Guide, including new information but also providing balanced guiding in the many areas where prospective data are still lacking. The outline of the original guide that addressed 15 clinical scenarios has been preserved, but all chapters have been rewritten. Main changes in the Update comprise a discussion on the definition of 'non-valvular AF' and eligibility for NOAC therapy, inclusion of finalized information on the recently approved edoxaban, tailored dosing information dependent on concomitant drugs, and/or clinical characteristics, an expanded chapter on neurologic scenarios (ischaemic stroke or intracranial haemorrhage under NOAC), an updated anticoagulation card and more specifics on start-up and follow-up issues. There are also many new flow charts, like on appropriate switching between anticoagulants (VKA to NOAC or vice versa), default scenarios for acute management of coronary interventions, step-down schemes for long-term combined antiplatelet-anticoagulant management in coronary heart disease, management of bleeding, and cardioversion under NOAC therapy. The Updated Guide is available in full in EP Europace (Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, Advisors. 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), while additional resources can be found at the related ESC/EHRA website (www.NOACforAF.eu).
Hasselt University and Heart Center, Stadsomvaart 11, Hasselt 3500, Belgium.
Hein
H
Heidbuchel
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Peter
P
Verhamme
Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands.
Marco
M
Alings
Department of Cardiology, Klinikum Oldenburg, Oldenburg, Germany.
Matthias
M
Antz
Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Hans-Christoph
HC
Diener
Department of Neurology, Ruprecht Karls Universität, Heidelberg, Germany.
Werner
W
Hacke
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Jonas
J
Oldgren
Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Peter
P
Sinnaeve
Clinical Cardiology, St George's University, London, UK.
A John
AJ
Camm
University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK.|Department of Cardiology and Angiology, University of Münster, Münster, Germany.
Paulus
P
Kirchhof
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control; D000075203:Contraindications, Drug; D003324:Coronary Artery Disease / Q000150:complications; D017558:Elective Surgical Procedures / Q000379:methods; D004554:Electric Countershock / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D009422:Nervous System Diseases / Q000150:complications; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
Anticoagulation; Atrial fibrillation; Bleeding; NOAC; Non-VKA oral anticoagulants; Pharmacology; Stroke