Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Summary of the document prepared by the Czech Society of Cardiology
Abstract
Non-vitamin K antagonist oral anticoagulants (NOACs) have emerged as an alternative for vitamin K antagonists (VKAs) for thrombo-embolic prevention in patients with non-valvular atrial fibrillation (AF). Some authors refer to these drugs as 'direct oral anticoagulants' (DOACs), but since the term NOAC has been used for many years and is widely recognized, we prefer to continue to use NOAC.
Non-vitamin K antagonist oral anticoagulants have an improved efficacy/safety ratio, predictable effect without need for routine monitoring, and fewer food and drug interactions compared with VKAs. However, the proper use of NOACs requires different approaches to many practical aspects compared with VKAs.
The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of NOACs. A first Practical Guide was published in 2013 to supplement the AF guidelines as a guidance for safe, effective use of NOAC when prescribed.
This text is a first update to the original Guide. A writing group formulated practical answers to 15 clinical scenarios, based on available and updated knowledge.
In some instances, the authors opted to make recommendations that do not fully align with all SmPC, with the goal to provide more uniform and simple practical advice. An EHRA website, www.NOACforAF.eu, accompanies the Practical Guide.