Key result
During the COVID-19 pandemic, interim guidance recommends starting DOACs instead of vitamin K antagonists for newly diagnosed oral anticoagulation indications to reduce routine monitoring visits.
Why the study?
DOAC adherence by patients and guideline adherence by physicians remain suboptimal, particularly amid the COVID-19 pandemic and selected challenging clinical scenarios.
During the COVID-19 pandemic, DOACs are preferred over VKAs for new oral anticoagulation indications to minimize healthcare exposure, though clinical challenges remain regarding adherence, kidney failure, and post-stroke timing.
Suboptimal DOAC adherence in AF warrants closer monitoring amid pandemics; leaves open optimal strategies for challenging scenarios.
PURPOSE OF REVIEW: Direct oral anticoagulants (DOAC) are crucial for the prevention of thromboembolic events in patients with nonvalvular atrial fibrillation. Drug adherence by the patient but also adherence to guidelines by the physician are suboptimal. This review highlights aspects of DOAC treatment during the coronavirus disease 2019 (COVID-19) pandemic and selected challenging scenarios. RECENT FINDINGS: For patients with a newly diagnosed indication for oral anticoagulation, a new interim clinical guidance recommends starting DOAC instead of vitamin K antagonists if DOAC are not contraindicated. The goal is to reduce the potential exposure of patients to severe acute respiratory syndrome coronavirus during the routine coagulation monitoring visits. As COVID-19 can lead to kidney failure, we discuss the challenges of DOAC dosing in kidney failures. Finally, we discuss two common challenges - when to start a DOAC after an ischemic stroke linked to atrial fibrillation, and whether cerebral microbleeds, including their count, are per se a contraindication to DOAC. SUMMARY: There are still open challenges regarding DOAC treatment on the patient and physician side, both related and unrelated to the pandemic.
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Dittrich et al. (2020) conducted a review in Nonvalvular atrial fibrillation and COVID-19. Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists was evaluated. During the COVID-19 pandemic, interim guidance recommends starting DOACs instead of vitamin K antagonists for newly diagnosed oral anticoagulation indications to reduce routine monitoring visits.
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