Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: Executive Summary of a Joint Consensus Document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, Endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).

Gregory Y H Lip, Jean Philippe Collet, Raffaele de Caterina, Laurent Fauchier, Deirdre A Lane, Torben B Larsen, Francisco Marin, Joao Morais, Calambur Narasimhan, Brian Olshansky, Luc Pierard, Tatjana Potpara, Nizal Sarrafzadegan, Karen Sliwa, Gonzalo Varela, Gemma Vilahur, Thomas Weiss, Giuseppe Boriani, Bianca Rocca

Journal: Thrombosis and haemostasis 2019;117(12):2215-2236

PMID: 29212110

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Abstract

Management strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc score risk factor components, rather than only the valve disease being causal. Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine. This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: (1) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and (2) EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into consideration CHA2DS2-VASc score risk factor components.

Address: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.; ACTION Study Group, Institut De Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Sorbonne Universite, Paris, France.; Institute of Cardiology, 'G. d'Annunzio' University, Chieti, Italy.; Centre Hospitalier Universitaire Trousseau et Faculté de Medicinde, Université François Rabelais, Tours, France.; Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.; Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.; Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal.; Department of Cardiac Electrophysiology, CARE Hospital, Hyderabad, Andhra Pradesh, India.; Clinical Cardiac Electrophysiology, Cardiology, Mercy Medical Center, Mason City, Iowa, United States.; Department of Cardiology, University Hospital Sart-Tilman, Liege, Belgium.; Cardiology Clinic, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia.; Isfahan Cardiovascular Research Center (WHO Collaborating Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.; School of Population and Public Health, University of British Columbia, Vancouver, Canada.; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, South Africa.; Mary McKillop Institute, ACU, Melbourne, Australia.; Servicio de Electrofisiología, Centro Cardiovascular Casa de Galicia, Hidalgos, Uruguay.; Cardiovascular Science Institute (ICCC), CIBERCV, IIB-Sant Pau, Hospital de la Sant Pau, Barcelona, Spain.; Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.; Faculty of Medicine, Sigmund Freud University, Vienna, Austria.; Department of Cardiology, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.; Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy.

DOI: 10.1160/TH-17-10-0709

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MeSH Terms: Administration, Oral, Africa, Southern, Asia, Atrial Fibrillation, Europe, Evidence-Based Medicine, Expert Testimony, Fibrinolytic Agents, Heart Valve Diseases, Humans, Latin America, Practice Guidelines as Topic, Risk, Stroke, Vitamin K