While both physicians and patients are becoming more accustomed to the use of non-vitamin K antagonist oral anticoagulants (NOACs) in clinical practice, questions remain on how to use NOACs in certain clinical scenarios. Many of these questions are addressed in a newly updated version of the European Heart Rhythm Association's (EHRA) Practical Guide on the use of NOACs in patients with atrial fibrillation, which was presented at EHRA 2018.
In developing the guide, the writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. These include issues such as practical start-up and follow-up schemes for patients on NOACs; pharmacokinetics and drug-drug interactions of NOAC; and management of bleeding under NOAC therapy.
Another new chapter briefly summarises the correct dosing of NOACs in conditions other than atrial fibrillation, such as prevention of deep venous thrombosis, treatment of venous thromboembolism, and treatment of ischaemic heart disease. “The dosing for each condition is different, which may lead to confusion, so we have outlined this clearly,” said senior author Professor Hein Heidbuchel.
The updated guide is published in the European Heart Journal and an executive summary is published in EP Europace.