4. PATHWAY SUMMARY GRAPHIC

Figure 1 provides an overview of what is covered in thedecision pathway. See each section for more detailedconsiderations and guidance.

FIGURE 1 PMAC Pathway Decision Algorithm Summary

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FIGURE 2 Detailed Algorithm: Whether to Interrupt and How to Interrupt for VKAs

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FIGURE 3 Detailed Algorithm: Whether to Interrupt, and How to Interrupt for DOACs

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FIGURE 4 Algorithm: Whether to Bridge and How to Bridge for DOACs and VKAs

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FIGURE 5 Algorithm: How to Restart Anticoagulation

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APPENDIX 3. ABBREVIATIONS

AF ¼ atrial fibrillation

COR ¼ Class of Recommendation

CrCl ¼ creatinine clearance

DOAC ¼ direct-acting oral anticoagulant

INR ¼ international normalized ratio

LMWH ¼ low molecular weight heparin

LOE ¼ Level of Evidence

NVAF ¼ nonvalvular atrial fibrillation

OAC ¼ oral anticoagulant

TI ¼ temporary interruption

TIA ¼ transient ischemic attack

UFH ¼ unfractionated heparin

VKA ¼ vitamin K antagonists

VTE ¼ venous thromboembolism

EXPERT CONSENSUS DECISION PATHWAY

2017 ACC Expert ConsensusDecision Pathway for PeriproceduralManagement of Anticoagulation inPatients With Nonvalvular Atrial FibrillationA Report of the American College of Cardiology Clinical Expert Consensus Document Task Force

PeriproceduralManagement ofAnticoagulationWritingCommittee

John U. Doherty, MD, FACC, Chair

Ty J. Gluckman, MD, FACCWilliam J. Hucker, MD, PHDJames L. Januzzi, JR, MD, FACC

Thomas L. Ortel, MD, PHDSherry J. Saxonhouse, MD, FACCSarah A. Spinler, PHARMD, AACC

Task Force onClinical ExpertConsensusDocuments

James L. Januzzi, JR, MD, FACC, Chair

Luis C. Afonso, MBBS, FACCBrendan Everett, MD, FACCJonathan Halperin, MD, FACCAdrian Hernandez, MD, FACCWilliam Hucker, MDHani Jneid, MD, FACCDharam Kumbhani, MD, SM, FACC

Eva M. Lonn, MD, FACCJoseph Marine, MD, FACCJames K. Min, MD, FACCPamela B. Morris, MD, FACCRobert Piana, MD, FACCJohn Puskas, MD, FACCKarol E. Watson, MD, FACCBarbara S. Wiggins, PHARMD, AACC

This document was approved by the American College of Cardiology Board of Trustees in November 2016.

The American College of Cardiology Foundation requests that this document be cited as follows: Doherty JU, Gluckman TJ, Hucker WJ, Januzzi Jr. JL,

Ortel TL, Saxonhouse SJ, Spinler SA. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with

nonvalvular atrial fibrillation. J Am Coll Cardiol 2017;XX:XXX–XX.

Copies: This document is available on the World Wide Web site of the American College of Cardiology (www.acc.org). For copies of this document,

please contact Elsevier Reprint Department, fax (212) 633-3820, or e-mail reprints@elsevier.com.

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