Europe
European Heart Rhythm Association (EHRA): 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation (Steffel et al, EP Europace 2021)
This updated guidance, published by the EHRA in 2021, provides evidence-based recommendations for the use of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF), including eligibility assessment; monitoring; transitioning between other anticoagulants and DOACs; possible drug-drug interactions (DDIs); dosing adjustments in the elderly, in patients with hepatic or renal impairment, or based on body weight; management of DOAC-associated bleeding (including use of reversal agents); and periprocedural management considerations for elective or emergency procedures (including ablation and cardioversion). Special considerations for DOAC use during the COVID-19 pandemic are also included. Sample pathways to help guide decision-making are included for various clinical scenarios.
European Society of Cardiology (ESC): 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC (Hindricks et al, Eur Heart J 2020 and SUPPL)
The ESC, in collaboration with the EACTS and developed with the EHRA, updated its 2016 guidelines for the screening, diagnosis, assessment, and management of atrial fibrillation (AF) in patients with or without comorbid cardiovascular disease (CVD), including valvular heart disease (direct oral anticoagulants [DOACs] are not indicated for use in patients with mechanical heart valves). Options for rate and rhythm control are described. Strategies for minimizing bleeding risk and managing bleeding episodes (including reversal options) are included, as are recommendations for periprocedural management of anticoagulation, including in patients undergoing ablation or cardioversion. Risks and benefits of DOACs and vitamin K antagonists (VKAs) are highlighted. Sample pathways to help guide decision-making are included for various clinical scenarios. These guidelines also include quality and performance indicators that may be used to evaluate the level of implementation of the guidelines and identify opportunities for improvement.
European Society of Cardiology (ESC): Oral Anticoagulation in Patients With Nonvalvular Atrial Fibrillation and a CHA2DS2-VASc Score of 1: A Current Opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke (Sulzgruber et al, Eur Heart J Cardiovasc Pharmacother 2019)
This consensus statement describes appropriate use of oral anticoagulation in patients with atrial fibrillation (AF) and a CHA2DS2-VASc score of 1 in men or 2 in women. An evidence-based algorithm for risk assessment and initiation of oral anticoagulation is provided
European Primary Care Cardiovascular Society (EPCCS): European Primary Care Cardiovascular Society (EPCCS) Consensus Guidance on Stroke Prevention in Atrial Fibrillation (SPAF) in Primary Care (Hobbs et al, Eur J Prev Cardiol [EJPC] 2016 and SUPPL)
This consensus statement, published in 2016, offers primary care providers evidence-based guidance on reduction of stroke risk in patients with AF. A sample pathway for anticoagulation assessment and initiation and comparisons of the safety and efficacy of vitamin K antagonists and direct oral anticoagulants (DOACs) are provided. The online supplement offers additional details about each section of the publication and includes dosing guidance for DOACs in patients with renal impairment.