COMMENTS ON 2016 EUROPEAN GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION: NEW ASPECTS FOR PHYSICIANS
Updated European guidelines for the management of atrial fibrillation were published on the 27 of August, 2016. This document is remarkable for new recommendations, especially about anticoagulation therapy. Key points of these guidelines and the possibility of their use in our country are described in the article.
Objective: to find out essential evidence-based key points of the 2016 guidelines and to investigate the possibility of their use in Kazakhstan.
Materials and methods: To achieve these goals major differences between 2016, 2012, 2010 guidelines were analyzed. Then, to find out investigations, that support key points of the 2016 guidelines, a literature review in PubMed, MEDLINE, Web of Science, Scopus databases were carried out. The following key words was used: atrial fibrillation, European guidelines, anticoagulation, warfarin, novel antagonist oral anticoagulants.
Results and conclusions: Aforementioned document is remarkable for inculcation of new essential recommendations, which can be listed in the next statements:
1. The prognostic value of the screening to determine silent atrial fibrillation has been highlighted.
2. EHRA symptom scale has been modified.
3. Changes in the CHA2 DS2-VASc scale using were introduced depend on gender.
4. Antiplatelet therapy is not recommended to prevent a stroke.
5. The role of novel anticoagulant has been strengthened in comparison with warfarin.
6. Edoxaban has been introduced as a recommended novel anticoagulant.
7. The possibility of the treatment with oral anticoagulant after intracranial haemorrhage has been scrutinized.
8. Algorithm about the use of oral anticoagulant after ischemic stroke has been developed.
9. The possibility of use double anticoagulant therapy instead of triple therapy among patients with atrial fibrillations after percutaneous coronary intervention has been proposed.
10. Statins are not recommended for primary prevention of atrial fibrillation.
Overall, this evidence-based approach will enable to improve the management of atrial fibrillation in Kazakhstan.
Akhmetzhan M. Galimzhanov, http://orcid.org/0000-0002-1605-9512
Semey State Medical University, The Department of internship in internal medicine, Semey, Kazakhstan.
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