Guidance released on use of new oral anticoagulants in nonvalvular afib

The European Heart Rhythm Association (EHRA) published guidance last week on using new oral anticoagulants in patients with nonvalvular atrial fibrillation (AF).

The guide was funded by industry through unrestricted educational grants and covers use of dabigatran, rivaroxaban and apixaban, as well as one other drug, edoxaban, that has yet to be approved in the U.S. or Europe. The goal, the authors said, was “to coordinate a unified way of informing physicians on the use of [new oral anticoagulants]” and to serve as an adjunct to the European Society of Cardiology's AF guidelines.

A working group reviewed available evidence and developed advice on the following concrete clinical scenarios:

• practical start-up and follow-up plans for patients taking new oral anticoagulants,
• measurement of the drugs' anticoagulant effects,
• drug-drug interactions and pharmacokinetics,
• how to switch between anticoagulant regimens,
• how to ensure compliance,
• how to handle dosing errors,
• use in patients with chronic kidney disease,
• how to handle a suspected overdose without bleeding, or a clotting test that indicates a risk of bleeding,
• management of bleeding complications,
• management of a planned surgical intervention or ablation,
• management of an urgent surgical intervention,
• use in patients with AF and coronary artery disease,
• cardioversion in a patient taking a new anticoagulant,
• management of patients presenting with acute stroke while taking a new anticoagulant, and
• comparison of new anticoagulants and vitamin K antagonists in patients with AF and a malignancy.

The guide was published in the May 5 Europace.

Additional information, including an executive summary and downloadable cards for patients, is available at the guide's accompanying website, which the authors said will be continually updated as new evidence becomes available.