ESC Congress 2017 In Review – Focus on Arrhythmias - 6

Main Session

Patients at high risk of bleeding remain undertreated, however, and Prof Wakili believes there is a need for
RCTs with NOACs for this cohort, as the evidence suggests that they benefit from NOAC treatment [Ruff CT
et al. Lancet. 2014].
If bleeding risks are too high for anticoagulants to be
used safely, another option is available to prevent thromboembolism related to AF. ESC guidelines state that LAA
occlusion may be used for stroke prevention in patients
with AF and contraindications for long-term OAC (eg,
those with a previous life-threatening bleed without a
reversible cause (class IIb, level of evidence B) [Kirchhof
P et al. Eur Heart J. 2016]. However, the level of evidence
for this recommendation remains low owing to the paucity of RCT data. In contrast, new data recently emerged
for NOACs in the setting of AF and CAD, and more specifically after PCI [Cannon CP et al. N Engl J Med. 2017;
Gibson CM et al. N Engl J Med. 2017]. Guidelines are being
rewritten to recommend NOAC treatment for this patient
group.
In conclusion, there is strong cumulative evidence
from general population data and RCTs that NOACs are
safer than and at least as effective as warfarin. However,
GI bleeding remains an issue and more data is needed
regarding elderly patients with end-stage kidney failure
and AF-CAD patients.

6

October 2017

M E D I C A L

P U B L I S H E R S

The editors would like to thank the many
members of the ESC Congress 2017
presenting faculty who generously gave
their time to ensure the accuracy and
quality of the articles in this publication

www.escardio.org/ESCcongressinreview

http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2017 In Review – Focus on Arrhythmias