- For treatment of nonvalvular Afib, most patients should receive nonvitamin K oral anticoagulants (NOACs) rather than warfarin (Coumadin; Bristol-Myers Squibb).
Why this matters
- Compared with warfarin, NOACs may carry less bleeding risk and prevent blood clots more effectively.
- Focused update to 2014 guideline for managing patients with Afib.
- Issued by American College of Cardiology, American Heart Association, and Heart Rhythm Society, and endorsed by the Society of Thoracic Surgeons.
- NOACs recommended over warfarin for nonvalvular Afib.
- Definition for nonvalvular Afib has been clarified as:
- Afib without moderate-severe mitral stenosis or mechanical heart valve.
- New treatment options: edoxaban (Savaysa; Daiichi Sankyo, Inc.) is a new oral anticoagulant option.
- Reversal agent options include:
- Idarucizumab (Praxbind) for dabigatran (Pradaxa; both Boehringer Ingelheim), and
- Andexanet alfa (Andexxa; Portola Pharmaceuticals, Inc.) for rivaroxaban (Xarelto; Janssen Pharmaceutica) and apixaban (Eliquis; Bristol-Myers Squibb).
- Substitution of “anticoagulant” for “antithrombotic.”
- New evidence regarding interrupting and bridging anticoagulation, catheter ablation, and Afib complicating acute coronary syndrome.
- Left atrial appendage occlusion device option discussed (Watchman; Boston Scientific).
- Prevention of thromboembolism: changes in language, evidence.
- New sections on weight loss, device detection of Afib.
- Weight loss recommended for overweight, obese patients.