2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation

Abstract

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).

Measurement of Dabigatran Concentration Using Finger Prick Dried Blood Spot Sample Collection

“…The dabigatran concentration range in our study was broad (41–1,400 ng/mL) compared to Foerster et al investigation in which all were <400 ng/mL ( Foerster et al, 2018 ). Further, compared to the data reported in clinical trials, which was 28–215 ng/mL for trough concentration and 52–383 ng/mL for peak concentration, around 65% of plasma-fpDBS pair had concentration being higher-than-expected range dabigatran concentrations ( Reilly et al, 2014 ; Steffel et al, 2021 ). The cause for increased dabigatran concentration can be multifocal, including ethnicity, and patient characteristics, such as higher proportion elderly, renal impairments, and higher CHA 2 DS 2 -VASc score.…”

Anticoagulation in Atrial Fibrillation Cardioversion: What Is Crucial to Take into Account

“…Indeed, in this specific setting the longer and variable time needed to achieve an effective anticoagulation with VKAs often requires the use of a heparin bridge and a delayed CV. NOACs' use in AF cardioversion is epidemiologically relevant in clinical practice [7,8].…”

“…Anticoagulation with heparin or NOACs should be started as soon as possible before CV (Class IIA). Moreover, regarding the type of strategy to choose in OAC-naive patients with AF of ≥48 h (or unknown) duration, ESC guidelines [4] and the European Heart Rhythm Association (EHRA) consensus document [8] suggest two options: an early imaging-guided strategy or a delayed non-imaging-guided strategy after regular and continued NOAC intake for at least 3 weeks before CV. For this clinical scenario, X-VeRT, ENSURE-AF, and EMANATE studies offered important data since most of the patients enrolled had an AF of ≥48 h duration (all patients in the first two studies).…”

“…According to EMANATE trial data an initial loading dose of 10 mg of apixaban (5 mg if does-adjustment criteria are applied) should be administered. Regarding the other NAC, a loading dose is not recommended [8].…”

Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians

“…Оказание качественной медицинской помощи этим пациентам требует комплексного подхода, учитывающего индивидуальные МНЕНИЕ ЭКСПЕРТОВ § особенности, с использованием алгоритмов выявления наиболее уязвимых пациентов и формированием персонализированного плана обследования, лечения и дальнейшего наблюдения с привлечением смежных специалистов, медицинских сестер, социальных работников. Международное кардиологическое сообщество в рекомендациях и консенсусах 2021 стало выделять пожилых пациентов с синдромом старческой астении в особую группу, рекомендации по которым прописываются отдельно [49,50]. Таким образом, использование скрининговых шкал для оценки старческой астении, взаимодействие с врачом-гериатром и понимание роли КГО для формирова-ния индивидуального плана ведения -это то, что должно шире использоваться в кардиологической практике.…”