2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: comment—Authors’ reply

We thank the authors for addressing this important issue.1 Indeed, the assessment of NOAC plasma levels—or potential alternatives—in special situations may represent an important element in the further refinement of non-vitamin K antagonist oral anticoagulant (NOAC) therapy. In their letter, Mbroh and Poli make a case for using point-of-care coagulation tests (POCT) to more rapidly assess the level of anticoagulant in patients’ blood samples. In the 2021 EHRA Practical Guide on the use of NOACs, we suggest to consider NOAC plamsa level assessment in two different types of scenarios: emergency situations (e.g. acute ischaemic stroke, necessity for urgent surgery) on the one hand, and uncertainty about steady state NOAC plasma levels (e.g. multiple drug–drug interactions, chronic kidney disease stage 4/5) on the other.2 While in the latter case POCT are not suitable to adequately address the clinical problem they may indeed play a role in emergency situations. The...