2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: comment —Authors’ reply

We thank the authors for addressing this important issue.1 Indeed, the assessment of NOAC plasma levels —or potential alternatives—in special situations may represent an important element in the further refinement of non-vitamin K antagonist oral anticoagulant (NOAC) therapy. In their letter, Mbroh and Poli make a case for using point-of-care coagulation tests (POCT) to more rapidly assess the lev el of anticoagulant in patients’ blood samples. In the 2021 EHRA Practical Guide on the use of NOACs, we suggest to consider NOAC plamsa level assessment in two different types of scenarios: emergency situations (e.g. acute ischaemic stroke, necessity for urgent surgery) on the one hand, and uncer tainty about steady state NOAC plasma levels (e.g. multiple drug–drug interactions, chronic kidney disease stage 4/5) on the other.2 While in the latter case POCT are not suitable to adequately address the clinical problem they may indeed play a role in emergency situations. The protocol using POCT as outlined by Mbroh and Poli has the advantage of rapid access which may be of great value in such situations. However, the proposed cut-off values appear rather conservative since these determine mainly the absence of any anticoagulant effect, and may exclude a substantial number of patients from receiving potentially beneficial therapy (e.g. thrombolysis, emergency surgery). On a more general level, this demonstrates a commonly encountered problem: the mere availability of technology ...
Source: Europace - Category: Cardiology Source Type: research