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Review
. 2015 Dec;67 Suppl 2(Suppl 2):S13-34.
doi: 10.1016/j.ihj.2015.10.380. Epub 2015 Nov 24.

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants

Jamshed Dalal  1 , Abhay Bhave  2 , Abraham Oomman  3 , Amit Vora  4 , Anil Saxena  5 , Dhiman Kahali  6 , Fali Poncha  7 , D S Gambhir  8 , Jaydip Ray Chaudhuri  9 , Nakul Sinha  10 , Saumitra Ray  11 , S S Iyengar  12 , Suvro Banerjee  13 , Upendra Kaul  14 ; SPAF Academy India experts
Affiliations
Review

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants

Jamshed Dalal et al. Indian Heart J. 2015 Dec.

Abstract

The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i) Dose recommendations of the NOACs in different clinical scenarios; (ii) NOACs in patients with rheumatic heart disease (RHD); (iii) Monitoring anticoagulant effect of the NOACs; (iv) Overdose of NOACs; (v) Antidotes to NOACs; (vi) Treatment of hypertrophic cardiomyopathy (HCM) with AF using NOACs; (vii) NOACs dose in elderly, (viii) Switching between NOACs and vitamin K antagonists (VKA); (ix) Cardioversion or ablation in NOAC-treated patients; (x) Planned/emergency surgical interventions in patients currently on NOACs; (xi) Management of bleeding complications of NOACs; (xii) Management of acute coronary syndrome (ACS) in AF with NOACs; (xiii) Management of acute ischemic stroke while on NOACs.

Keywords: AF; Apixaban; Dabigatran; Rivaroxaban; SPAF.

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Figures

Fig. 1
Fig. 1
Limitations of vitamin K therapy.
Fig. 2
Fig. 2
Efficacy and safety of NOACs.
Fig. 3
Fig. 3
Management of acute coronary syndrome in atrial fibrillation.
Fig. 4
Fig. 4
Stroke management in patients on NOACs: (<4.5 h of symptom onset).
See this image and copyright information in PMC

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