Education and Innovation in Cardiovascular Medicine

ESC publishes guidelines for use of new oral anticoagulant drugs with atrium fibrillation

The European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC) has published a practical guide on the use of new oral anticoagulants (NOACs). The document summarises existing information on different drugs, to answer clinical questions that fall outside what drug companies can legally answer, and to make clear what the similarities and differences are.
Companies provide a Summary of Product Characteristics (SmPC) for their drug but the content is bound by legal restrictions. The current EHRA guide is more specific than the SmPCs and provides expert guidance on what to do in specific clinical situations. The EHRA worked in close collaboration with the drug companies to ensure that all of the information in the SmPCs is also in the guide.
Fifteen clinical scenarios are given with practical information on how to handle them. The clinical situations include how to initiate and monitor NOAC use, how to measure the anticoagulant effect if needed in specific situations, switching between anticoagulants, ensuring compliance, patients with chronic kidney disease and management of bleeding complications.
ESC guidelines on atrial fibrillation recommend the NOACs as preferable to vitamin K-antagonists for stroke prevention in patients with non-valvular atrial fibrillation.
Unlike vitamin K-antagonists, NOACs do not require regular monitoring of anticoagulation level. Since the novel anticoagulant drugs have a very short half-life, patients are not protected when they stop taking the drug. Therefore, suggestions are given on how to improve compliance.
Furthermore, the document advises how to switch safely from a vitamin K-antagonist to a NOAC. The bleeding risk profile of the NOACs is better than that of vitamin K-antagonists. But bleedings will occur, so the practical document also outlines what action should be taken in the event of bleeding.
“Like all new drugs, also NOACs have pitfalls. Physicians who follow the practical advices in this guide will improve the safety of their patients,” according to Professor S. Hohnloser, who is a reviewer of the EHRA guide and member of the ESC atrial fibrillation guidelines task force.
The full guide ‘NOAC for AF’, an executive summary and  print-ready patient cards can be found on
Source: press release of ESC 26 April 2013


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