Guide steers physicians through anticoagulant quagmires

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 - Crossroads

The European Heart Rhythm Association (EHRA) has produced a practical guide to help physicians care for atrial fibrillation patients on new oral anticoagulants. The project includes educational materials available on a website that will be updated as new information becomes available.

A full paper was published April 26 in EP-Europace and an executive summary was published online in European Heart Journal.

Drugs such as dabigatran (Pradaxa, Boehringer Ingelheim) and rivaroxaban (Xarelto, Janssen Pharmaceuticals/Bayer Healthcare) offer an alternative to the vitamin K antagonist warfarin for the prevention of stroke in patients with nonvalvular atrial fibrillation. But it is not always clear how physicians should manage these new anticoagulants in the some clinical situations. The guide is divided into sections that spell out 15 scenarios. Those are:

  • Initiation and follow-up schemes for patients;
  • Measuring anticoagulant effects;
  • Drug–drug interactions and pharmacokinetics;
  • Switching between anticoagulant regimens;
  • Ensuring compliance of drug intake;
  • Dealing with dosing errors;
  • Patients with chronic kidney disease;
  • Dealing with a suspected overdose;
  • Management of bleeding complications;
  • Planned surgical intervention or ablation;
  • Urgent surgical intervention;
  • Patients with atrial fibrillation and coronary artery disease;
  • Cardioversion in a patient treated with new oral anticoagulants;
  • Patients presenting with acute stroke; and
  • New oral anticoagulants vs. vitamin K antagonists in atrial fibrillation patients with a malignancy.

The guide provides several tools that physicians can access through the website Those include a proposed universal card that the patient should complete and carry. The card spells out instructions for the patient and lists medication and other information for healthcare professionals. The guide also offers a booklet, a structured follow-up protocol and an alert for drug-drug interactions.

The website links to the European Society of Cardiology (ESC) Atrial Fibrillation Guidelines. The EHRA is a branch of ESC.

The guide was funded through education grants from Boehringer Ingelheim, Bayer, Daiichi-Sankyo and the Pfizer/BMS Alliance.