A ‘practical guide’ to the new oral anticoagulants that have recently become available as an alternative to warfarin for patients with atrial fibrillation has been issued by the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).
The guide, which has been published online in the European Heart Journal and Europace, covers four new oral anticoagulants: dabigatran, rivaroxaban and apixaban (which are all now on the market for AF), and edoxaban, which is included provisionally, as it is not yet approved.
The guide notes that: “Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice,” and “Many unresolved questions on how to optimally use these drugs in specific clinical situations remain”.
It sets out 15 clinical scenarios and gives “as practical answers as possible” for each one. The topics are:
- Practical start-up and follow-up scheme for patients on new anticoagulants
- How to measure the anticoagulant effect of the new drugs
- Drug–drug interactions and
- Switching between anticoagulant regimens
- Ensuring compliance
- How to deal with dosing errors
- Patients with chronic kidney disease
- What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding?
- Management of bleeding complications
- Patients undergoing a planned surgical intervention or ablation
- Patients undergoing an urgent surgical intervention
- Patients with AF and coronary artery disease
- Patients presenting with acute stroke
- Patients with a malignancy.
Since new information is becoming available at a rapid pace, the guide will be updated regularly on the EHRA website.
The full guide is available at: Europace 2013;15:625-51; and Eur Heart J (published online 26th April 2013, doi:10.1093/eurheartj/eht134).