Abstract
In recent years the management of atrial fibrillation patients has progressively and
substantially changed because of the introduction of new treatments and the availability
of new data regarding the epidemiology and clinical management of these patients.
In the past 2 years alone, there have been 7 new guidelines or guideline updates that
have been published, which have introduced new recommendations and significantly revised
previously published ones. Two updates for Canadian guidelines were published in 2016
and 2018, whereas guidelines from the European Society of Cardiology in 2016, Asia
Pacific Heart Rhythm Society were published in 2017, National Heart Foundation of
Australia/Cardiac Society of Australia and New Zealand, American College of Chest
Physicians, and Korean Heart Rhythm Society have been published in 2018. In this narrative
review we provide a comparison of these contemporary international guidelines, with
particular attention on the evaluation of thromboembolic and bleeding risks and management
of oral anticoagulant therapy. From the analysis of contemporary guidelines on the
management of atrial fibrillation, a general agreement is evident about the baseline
evaluation of thromboembolic and bleeding risk, as well as a preference for the use
of non-vitamin K antagonist oral anticoagulants. Also, regarding the concomitant use
of oral anticoagulant and antiplatelet drugs in patients with acute coronary syndromes,
undergoing elective percutaneous coronary intervention, catheter ablation, and cardioversion
procedures, all of the guidelines agree on the general principles and are supported
by evidence. More data are still needed to better substantiate recommendations for
specific atrial fibrillation subpopulations. The need for an integrated approach and
holistic management is highlighted in the more recently published guidelines.
Résumé
Ces dernières années, la prise en charge des patients atteints de fibrillation auriculaire
a progressivement et considérablement changé en raison de l’introduction de nouveaux
traitements et de la disponibilité de nouvelles données sur l’épidémiologie et la
prise en charge clinique de ces patients. Au cours des deux dernières années seulement,
les sept nouvelles lignes directrices ou mises à jour de lignes directrices qui ont
été publiées ont introduit de nouvelles recommandations et ont tenu compte de l’importante
révision des lignes directrices publiées antérieurement. Deux mises à jour des lignes
directrices canadiennes ont été publiées en 2016 et en 2018, alors que les lignes
directrices de la Société européenne de cardiologie ont été publiées en 2016, celles
de la Asia Pacific Heart Rhythm Society, en 2017, et celles de la National Heart Foundation
of Australia and Cardiac Society of Australia and New Zealand, du American College
of Chest Physicians et de la Korean Heart Rhythm Society, en 2018. Dans la présente
revue narrative, nous faisons la comparaison de ces lignes directrices internationales
contemporaines et portons une attention particulière à l’évaluation du risque thromboembolique
et du risque hémorragique, et à la prise en charge de l’anticoagulothérapie par voie
orale. À partir de l’analyse des lignes directrices contemporaines sur la prise en
charge de la fibrillation auriculaire, on remarque un consensus évident sur l’évaluation
initiale du risque thromboembolique et du risque hémorragique, ainsi que sur la préférence
pour l’utilisation d’anticoagulants antivitamine K par voie orale. De plus, pour ce
qui est de l’utilisation concomitante de médicaments anticoagulants et de médicaments
antiplaquettaires par voie orale chez les patients atteints de syndromes coronariens
aigus, qui subissent une intervention coronarienne percutanée non urgente, une ablation
par cathéter et des cardioversions, l’ensemble des lignes directrices s’harmonisent
aux principes généraux et sont fondées sur des données probantes. Plus de données
sont encore nécessaires pour mieux étayer les recommandations de certaines sous-populations
atteintes de fibrillation auriculaire. La nécessité d’une approche intégrée et d’une
prise en charge holistique est mise en évidence dans les plus récentes lignes directrices
publiées.
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Article info
Publication history
Published online: February 21, 2019
Accepted:
February 15,
2019
Received:
December 11,
2018
Footnotes
See page 631 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
