- Edoxaban has been added to the list of nonvitamin K oral anticoagulants (NOACs [apixaban, dabigatran, and rivaroxaban]) that can be used for stroke prevention.
- NOACs are recommended over warfarin except in patients with moderate to severe mitral stenosis or a prosthetic heart valve.
- The decision to use an anticoagulant should not be influenced by whether the AF is paroxysmal or persistent.
- Renal and hepatic function should be tested before initiation of a NOAC and at least annually thereafter.
- In AF patients with a CHA2DS2-VASc score ≥2 in men or ≥3 in women and a creatinine clearance <15 ml/min or who are on dialysis, it is reasonable to use warfarin or apixaban for oral anticoagulation.
- Idarucizumab is recommended for the reversal of dabigatran in the event of a life-threatening bleed or urgent procedure.
- Andexanet alfa (recombinant factor Xa) can be useful for the reversal of rivaroxaban and apixaban in the event of life-threatening bleeding.
- Percutaneous left atrial appendage occlusion may be considered for at-risk AF patients with AF at increased risk of stroke who have contraindications to long-term anticoagulation.
- AF catheter ablation may be reasonable in symptomatic patients with heart failure and a reduced ejection fraction to reduce mortality and heart failure hospitalisations.
- In at-risk AF patients who have undergone coronary artery stenting, double therapy with clopidogrel and low-dose rivaroxaban (15 mg daily) or dabigatran (150 twice daily) is reasonable to reduce the risk of bleeding as compared to triple therapy.
- Weight loss combined with risk factor modification is recommended for overweight and obese patients with AF.
- In patients with cryptogenic stroke in whom external ambulatory monitoring is inconclusive, implantation of a cardiac monitor is reasonable for detection of subclinical AF.
2019 AHA/ACC/HRS Guideline for the Management of AF
Published on : Thu, 7 Feb 2019
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