Table 1.

Recommendations regarding anticoagulation in atrial fibrillation (AF) patients during the coronavirus disease 2019 (COVID-19) pandemic.

In non-infected patients, it is advisable to switch from VKAs to NOACs whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Anticoagulation principles in quarantined or asymptomatic individuals remain unchanged and NOACs are the preferred anticoagulants in the vast majority of AF patients. We recommend continuing NOAC therapy in mildly symptomatic COVID-19-infected AF patients who do not require hospitalization. We recommend continuing NOAC treatment or switching to therapeutic dosing of LMWH in AF patients hospitalized due to mild or moderate COVID-19 pneumonia. When deciding about anticoagulation, potential interactions of NOACs with anti-COVID-19 medications and co-morbidities (e.g., impaired renal function) should be considered. We recommend anticoagulation with either LMWH or UFH in critically ill COVID-19 patients with AF hospitalized in intensive care units. In AF patients treated with VKA and admitted to the hospital due to COVID-19 infection, including those with prosthetic heart valves or moderate/severe mitral stenosis, we suggest switching anticoagulation to LMWH or UFH. The anticoagulation treatment strategy in COVID-19 patients with AF, particularly in critical scenarios, should be individualized based on possible drug-drug interactions.

LMWH — low-molecular-weight heparin; NOAC — non-vitamin K antagonist oral anticoagulant; UFH — unfractionated heparin; VKA — vitamin K antagonist