AHA Updates Guidelines for Anticoagulants in AFib
Non-vitamin K oral anticoagulants (NOACs) are now the preferred alternative to warfarin for reducing the risk for stroke in atrial fibrillation (AFib), according to updated guidelines from the American Heart Association, American College of Cardiology, and Heart Rhythm Society.1
However, NOACs—which include dabigatran, rivaroxaban, apixaban, and edoxaban—should not be the preferred alternative if the patient has moderate to severe mitral stenosis or an artificial heart valve.
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“Patients with AFib are at increased risk of stroke, which can be devastating. A goal of treating AFib patients is to make blood less likely to form clots, which reduces the risk of stroke. New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin,” said Dr Craig T January, co-chair of the focused update.2
The updated guidelines also suggest that NOACs could be used in individuals who are at lower risk for stroke than previously thought. While this recommendation’s evidence is not definitive, new research does suggest that the benefit of NOACs for reducing stroke risk outweighs the risk of taking them.
The guidelines highlight the fact that reversal agents for NOACs are available. Though they are not readily used, the drugs can be helpful when there are signs of NOAC-related severe bleeding or when a patient on a NOAC needs an emergency surgical procedure.
The guidelines also recommend that individuals with AFib who have overweight or obesity should lose weight in order to reduce—and possibly reverse—the health risks associated with AFib.
The recommendations are an update to the organizations’ Guideline for the Management of Patients With Atrial Fibrillation that was released in 2014.
—Colleen Murphy
References:
1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation [published online January 28, 2019]. Circulation. https://doi.org/10.1161/CIR.0000000000000665.
2. Updated treatment guidelines for atrial fibrillation recommend a new class of blood thinners to help prevent stroke: AHA/ACC/HRS focused update [press release]. Dallas, TX: American Heart Association; January 28, 2019. https://newsroom.heart.org/news/updated-treatment-guidelines-for-atrial-fibrillation-recommend-a-new-class-of-blood-thinners-to-help-prevent-stroke. Accessed January 28, 2019.