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What is the most updated consensus regarding the use of pill in the pocket oral anticoagulation in paroxysmal atrial fibrillation, and populations of patients who are most likely to be considered for enrollment in clinical trials?

Which DOAC(s) could be best suited for pill in the pocket anticoagulation RCTs?
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When would you consider using the pill-in-the-pocket approach for oral anticoagulation in patients with paroxysmal atrial fibrillation?

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3 Answers
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Cardiology · Westchester Medical Center/New York Medical College
Answered on

I'm not sure that there is a consensus. The best available large trial data would recommend anticoagulation based on a CHADS2Vasc score of 2 or higher, while a score of 0 patients could be off anticoagulation, and if the score is 1, patients would benefit from shared decision-making. For the CHADS2V...

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Cardiology · Lankenau Heart Group
Answered on

This question is the hypothesis being studied in REACT. Until we have data that this is a safe and effective strategy, I believe that we should maintain continuous anticoagulation in patients who we deem to be at a substantial stroke risk.

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Cardiology · Baylor College of Medicine/ Texas Children's Hospital
Answered on · Updated on

I don't think there is a consensus on pill-in-a-pocket oral anticoagulation for paroxysmal atrial fibrillation, and I agree we should see what REACT-AF shows us, but it started in July 2023 and doesn't anticipate completion until July 2029. In the meantime, I routinely utilize pill-in-a-pocket antic...

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