Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
Europace. 2013 May;15(5):625-51. doi: 10.1093/europace/eut083.
New oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group listed 15 topics of concrete clinical scenarios and formulated as practical answers as possible based on available evidence. The 15 topics are: (1) Practical start-up and follow-up scheme for patients on NOACs; (2) How to measure the anticoagulant effect of NOACs; (3) Drug-drug interactions and pharmacokinetics of NOACs; (4) Switching between anticoagulant regimens; (5) Ensuring compliance of NOAC intake; (6) How to deal with dosing errors; (7) Patients with chronic kidney disease; (8) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding? (9) Management of bleeding complications; (10) Patients undergoing a planned surgical intervention or ablation; (11) Patients undergoing an urgent surgical intervention; (12) Patients with AF and coronary artery disease; (13) Cardioversion in a NOAC-treated patient; (14) Patients presenting with acute stroke while on NOACs; (15) NOACs vs. VKAs in AF patients with a malignancy. Since new information is becoming available at a rapid pace, an EHRA Web site with the latest updated information accompanies this text (www.NOACforAF.eu).
新型口服抗凝剂（NOACs）是维生素 K 拮抗剂（VKAs）的替代品，可用于预防非瓣膜性心房颤动（AF）患者的中风。医生和患者都必须学会在临床实践中有效地、安全地使用这些药物。在特定临床情况下如何最佳使用这些药物，仍存在许多悬而未决的问题。欧洲心脏病学会心律协会（EHRA）着手协调一种统一的方法，向医生告知不同 NOAC 的使用情况。一个写作小组列出了 15 个具体临床情况的主题，并根据现有证据尽可能制定出实用的答案。这 15 个主题是：（1）NOAC 患者的实际启动和随访方案；（2）如何测量 NOAC 的抗凝效果；（3）NOAC 的药物相互作用和药代动力学；（4）抗凝方案的转换；（5）确保 NOAC 摄入的依从性；（6）如何处理剂量错误；（7）慢性肾脏病患者；（8）如果没有出血，或凝血试验提示出血风险，该怎么办？（疑似）过量或过量？（9）出血并发症的管理；（10）计划进行手术干预或消融的患者；（11）紧急手术干预的患者；（12）AF 合并冠心病患者；（13）NOAC 治疗患者的电复律；（14）在服用 NOAC 时出现急性中风的患者；（15）AF 合并恶性肿瘤患者的 NOACs 与 VKAs。由于新信息以快速的速度出现，EHRA 网站提供了最新的更新信息（www.NOACforAF.eu）。
