The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug-drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of NOACs; (8) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu).

中文翻译：

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2018年欧洲心律协会非维生素K拮抗剂口服抗凝剂治疗房颤患者实用指南

目前的手稿是 2013 年出版的原始实用指南的第二次更新 [Heidbuchel et al. 欧洲心律协会关于在非瓣膜性房颤患者中使用新型口服抗凝剂的实用指南。欧洲空间 2013;15:625-651; 海德布切尔等人。关于在非瓣膜性房颤患者中使用非维生素 K 拮抗剂抗凝剂的最新欧洲心律协会实用指南。欧洲空间站 2015；17:1467-1507]。非维生素 K 拮抗剂口服抗凝剂 (NOAC) 是维生素 K 拮抗剂 (VKA) 的替代品，可预防房颤 (AF) 患者中风，并已成为首选，特别是在新开始抗凝治疗的患者中。医生和患者都越来越习惯于在临床实践中使用这些药物。然而，关于如何在特定临床情况下最佳使用这些药物的许多未解决的问题仍然存在。欧洲心律协会 (EHRA) 着手协调以统一的方式通知医生使用不同的 NOAC。一个写作小组根据现有证据确定了 20 个具体临床场景的主题，并为其制定了切实可行的答案。这 20 个主题如下：（1）NOAC 的资格；（2）NOACs患者的实用启动和随访方案；(3) 确保遵守规定的口服抗凝剂摄入量；(4) 抗凝方案之间的切换；(5) NOACs的药代动力学和药物相互作用；（6）慢性肾病或晚期肝病患者的NOACs；(7)如何测定NOACs的抗凝作用；(8) NOAC血浆水平测量：罕见的适应症、预防措施和潜在的陷阱；(9) 加药错误如何处理；(10) 如果（疑似）过量服用但不出血，或凝血试验表明有出血的潜在风险怎么办；(11) NOAC治疗下出血的处理；(12) 进行有计划的侵入性手术、手术或消融的患者；(13) 需要紧急手术干预的患者；(14) 房颤合并冠状动脉疾病患者；(15) 避免与不同适应症的 NOAC 给药混淆；(16) 接受 NOAC 治疗的患者的心脏复律；(17) 使用 NOAC 时出现急性卒中的 AF 患者；（十八）特殊情况下的NOAC；(19) AF 恶性肿瘤患者的抗凝治疗；(20)优化VKA剂量调整。