A new decision pathway for the management of patients with nonvalvular atrial fibrillation (AFib) who are taking anticoagulants and need surgery was published Jan. 9 in the Journal of the American College of Cardiology.

The document provides guidance to physicians on:

• The overall decision to keep a patient chronically on an anticoagulant by examining whether anticoagulation is warranted based on overall thrombotic risk
• The decision to take the patient off an anticoagulant temporarily
• How to temporarily stop the use of vitamin K antagonists and direct-acting oral anticoagulants
• Deciding if “bridging” a patient before, during and after surgery is the best choice
• Deciding how to bridge before, during and after surgery
• Deciding how and when to restart the patient’s regular anticoagulant after a surgery

The authors explain that managing patients during this time period is often challenging and varies among hospitals, practitioners and specialties. Typically, no matter where a patient is being treated, many specialists contribute to the decision-making process.

“All these specialists possess valuable knowledge; however, they have differing perspectives, which can make the decision-making process complex,” said John U. Doherty, MD, FACC, chair of the writing committee. “With this new decision pathway, physicians will be able to make better-informed decisions, and this will contribute to improved patient outcomes. In North America alone, more than 250,000 nonvalvular AFib patients undergo surgery annually, so this document will impact many people.”

Keywords: Anticoagulants, Arrhythmias, Cardiac, Secondary Prevention

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