2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Indications for measurement of NOAC serum levels might include: ▪Measurement of drug levels in patients undergoing urgent surgical procedures. ▪Uncovering accumulation of potentially toxic drug levels in patients with CKD or those undergoing dialysis. ▪Detection of potential drug–drug interactions to guide dose adjustment. ▪Evaluation of drug absorption in severely obese patients (body mass index >35 or weight >120 kg) ▪Assessment of patient adherence. 4.3 Interruption and Bridging Anticoagulation Recommendations for Interruption and Bridging AnticoagulationReferenced studies that support new or modified recommendations are summarized in Online Data Supplement 3.CORLOERecommendationsIC Bridging therapy with unfractionated heparin or low-molecular-weight heparin is recommended for patients with AF and a mechanical heart valve undergoing procedures that require interruption of warfarin. Stroke rates are higher in patients with MI and AF than in those without AF (3.1% for those with AF versus 1.3% for those in sinus rhythm) (S7.4-11). [...]AF is an independent predictor of poor long-term outcome in patients with ACS (S7.4-13, S7.4-14). Of the patients treated with triple therapy for 1 month in the Bern PCI Registry, 60% were treated with a current-generation drug-eluting stent. 7.12 Device Detection of AF and Atrial Flutter (New) Recommendations for Device Detection of AF and Atrial FlutterReferenced studies that support new recommendations are summarized in Online Data Supplement 9.CORLOERecommendationsIB-NR In patients with cardiac implantable electronic devices (pacemakers or implanted cardioverter-defibrillators), the presence of recorded atrial high-rate episodes (AHREs) should prompt further evaluation to document clinically relevant AF to guide treatment decisions (S7.12-1–S7.12-5).IIaB-R In patients with cryptogenic stroke (i.e., stroke of unknown cause) in whom external ambulatory monitoring is inconclusive, implantation of a cardiac monitor (loop recorder) is reasonable to optimize detection of silent AF (S7.12-6). Presidents and Staff American College of Cardiology C. Michael Valentine, MD, FACC, President Timothy W. Attebery, DSc, MBA, FACHE, Chief Executive Officer William J. Oetgen, MD, MBA, FACC, FACP, Executive Vice President, Science, Education, Quality, and Publishing MaryAnne Elma, MPH, Senior Director, Science, Education, Quality, and Publishing Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publishing American