NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Atrial fibrillation guideline updated

The GGC Heart MCN guideline for atrial fibrillation (AF) management has been updated.  The objectives of treatment are:

  • Prevention of stroke
  • Symptom relief
  • Optimal management of concomitant cardiovascular disease
  • Rate control
  • Correction of rhythm disturbance

 

The main changes affect the flowchart on prevention of thromboembolism in non-valvular AF (NVAF) using CHADS2 and CHA2DS2-VASC scores.  The option of a novel oral anticoagulant (NOAC) for new diagnoses as an alternative to warfarin is available. There is guidance on the pros and cons of different products. For patients with very low risk, there is a message about when no anti-thrombotic is indicated.

 

The Guidance on anticoagulant choice in patients with NVAF has also been updated. Information is provided on estimation of renal function using Cockcroft and Gault to calculate creatinine clearance, as this is the measurement defined in the manufacturer’s summary of product characteristics for determining dose adjustments in renal impairment.

 

Rivaroxaban is indicated in patients with NVAF restricted to those:

  • currently receiving warfarin who have poor INR control despite evidence that they are complying
  • with allergy or intolerable side effects from coumarin anticoagulants

for whom warfarin has been clinically excluded as a therapeutic option but anticoagulation is deemed safe and appropriate