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Anticoagulation in atrial fibrillation and chronic heart failure: the risk and drug of choice

Boos, Christopher J.; Brown, Louise

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 229–234
doi: 10.1097/HCO.0000000000000245
HEART FAILURE: Edited by Haissam Haddad

Purpose of review This review seeks to provide an evidence-based update on the issue of atrial fibrillation and chronic heart failure with an emphasis on anticoagulation and the expanding use of the novel oral anticoagulants (NOACs).

Recent findings There is an increasing appreciation of the important reciprocal relationship between atrial fibrillation and heart failure and the negative prognostic impact that each condition has on the other. There are now four NOACs approved for stroke prevention in atrial fibrillation. There are increasing data to support their use in atrial fibrillation with heart failure, including in patients with nonmechanical or rheumatic valvular disease, and to facilitate direct current cardioversion. The choice of NOAC is heavily dependent on individual patient characteristics.

Summary The use of and indications for NOACs for patients with heart failure and atrial fibrillation are rapidly increasing.

aDepartment of Cardiology, Poole Hospital NHS Foundation Trust, Poole

bDepartment of Postgraduate Medical Education, Bournemouth University, Bournemouth, UK

Correspondence to Christopher J. Boos, Department of Cardiology, Poole Hospital NHS Foundation Trust, Longfleet Rd, Poole, Dorset, BH15 2JB, UK. Tel: +44 01202 44 2572; fax: +44 01202 44 2754; e-mail:

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