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Cited by 2,123Atrial Fibrillation Management and OutcomesVenous Thromboembolism Diagnosis and ManagementAcute Ischemic Stroke Management

The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

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Steffel, Jan, Verhamme, Peter, Potpara, Tatjana S, Albaladejo, Pierre, Antz, Matthias, Desteghe, Lien, Haeusler, Karl Georg, Oldgren, Jonas +19 more·2018·European Heart Journal
DOI 10.1093/eurheartj/ehy136
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Abstract

The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. 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 et al. 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]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug–drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of 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).

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  • Patients receiving oral anticoagulants (OAC) are prone to trauma.

    “Patients receiving OAC should not participate in sports with direct bodily contact and are prone to trauma [89].”

    From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [89]

    Section 18.4, “Non-vitamin K antagonist oral anticoagulants in Athletes” (page not provided), reports traditional advice that athletes taking OAC for venous thromboembolism avoid contact sports during treatment. It does not say that OAC makes patients prone to trauma, and the advice is narrower than a recommendation for all patients receiving OAC. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Steffel, J., Verhamme, P., Potpara, T. S., Albaladejo, P., Antz, M., Desteghe, L., Haeusler, K. G., Oldgren, J., Reinecke, H., Roldan-Schilling, V., Rowell, N., Sinnaeve, P., Collins, R., Camm, A. J., Heidbüchel, H., ESC Scientific Document Group, Lip, G. Y. H., Weitz, J., Fauchier, L., Lane, D., Boriani, G., Goette, A., Keegan, R., MacFadyen, R., Chiang, C.-E., Joung, B., & Shimizu, W.
Affiliations
  • Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
  • KU Leuven (BE)
  • University of Belgrade (RS)
  • Centre Hospitalier Universitaire de Grenoble (FR)
  • Klinikum Braunschweig (DE)
  • Hasselt University (BE)
  • Center for Stroke Research Berlin and Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
  • Uppsala University (SE)
  • University Hospital Münster (DE)
  • University of Murcia, Murcia, Spain
  • Middlesbrough, UK
  • Age-Related Health Care & Stroke-Service, Tallaght Hospital, Dublin Ireland
  • St George's, University of London (GB)
  • Antwerp University Hospital (BE)
  • Bristol-Myers Squibb (United States) (US)
Corresponding author
Steffel, Jan
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2018-03-19
Volume
39
Issue
16
Pages
1330-1393
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehy136
OpenAlex
W2792857103
Cited by
2,123
References
31
Citations by year
2026: 49 · 2025: 98 · 2024: 162 · 2023: 217 · 2022: 260 · 2021: 382 · 2020: 454 · 2019: 334 · 2018: 133 · 2017: 22 · 2016: 7 · 2012: 1
FWCI
246.48
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/about_us/legal/notices (vor)
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • Document Server@UHasselt (UHasselt) (submittedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
Funders
  • Bristol-Myers Squibb
  • Pfizer
  • Daiichi-Sankyo
  • Daiichi Sankyo Europe
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
direct oral anticoagulants, atrial fibrillation, stroke prevention, anticoagulation management, anticoagulant switching, anticoagulation adherence, drug-drug interactions, renal dysfunction, liver disease, anticoagulation monitoring, hemorrhage control, emergency surgery, coronary artery disease, atrial fibrillation ablation, anticoagulant overdose
MeSH terms
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Female, Humans, Male, Stroke, Acute Coronary Syndrome, Percutaneous Coronary Intervention

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