Atrial fibrillation
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Initial tests
Laboratory tests
- FBC
- PT, aPTT
- Serum electrolytes
- Serum creatinine with eGFR
- TSH
- Fasting plasma glucose
- CRPif neededIf the history or examination points to an infectious or inflammatory trigger: bronchopulmonary infection, fever or other acute episode, diarrhoea [1]. CRP is listed “as needed” in the list of procedures for ALD 5 [2].
- ASTif neededPre-treatment tests before anticoagulation (caution if ALT/AST > 2 × ULN or bilirubin ≥ 1.5 × ULN, for example with apixaban).
- ALTif neededPre-treatment tests before anticoagulation (caution if ALT/AST > 2 × ULN or bilirubin ≥ 1.5 × ULN, for example with apixaban).
- GGTif neededPre-treatment tests before anticoagulation (caution if ALT/AST > 2 × ULN or bilirubin ≥ 1.5 × ULN, for example with apixaban).
- ALPif neededPre-treatment tests before anticoagulation (caution if ALT/AST > 2 × ULN or bilirubin ≥ 1.5 × ULN, for example with apixaban).
- Total bilirubinif neededPre-treatment tests before anticoagulation (caution if ALT/AST > 2 × ULN or bilirubin ≥ 1.5 × ULN, for example with apixaban).
Also consider
- On a DOAC? If a direct oral anticoagulant is prescribed, see the "Treatment: direct oral anticoagulant" page.
- On a vitamin K antagonist? If a vitamin K antagonist is prescribed, see the "Treatment: vitamin K antagonist (VKA)" page.
- On amiodarone? If amiodarone is prescribed, see the "Treatment: amiodarone" page.
Do not order
Follow-up tests
Laboratory tests
- Serum electrolytes
- Serum creatinine with eGFR
- Serum creatinine with eGFR, additional check (clearance ≤ 60 mL/min, age ≥ 75 years or frailty)if needednon-French guidelineOn a DOAC, if creatinine clearance is ≤ 60 mL/min: minimum interval between checks in months equal to the clearance divided by 10 (for example every 4 months for 40 mL/min); every 4 months in patients aged 75 or over (especially on dabigatran) or frail [8]. Also in case of intercurrent illness that may affect kidney function (infection, non-steroidal anti-inflammatory drug, dehydration) [8].
- FBC (if on a DOAC)if neededIf DOAC.
- Monthly INR (if on a vitamin K antagonist)if neededIf VKA.
- TSH (if on amiodarone)if neededIf amiodarone.
- ASTif neededOn a DOAC: liver function before treatment and then at least once a year [1]; edoxaban: regular monitoring beyond one year [4]; amiodarone: regular monitoring of liver function during treatment [9].
- ALTif neededOn a DOAC: liver function before treatment and then at least once a year [1]; edoxaban: regular monitoring beyond one year [4]; amiodarone: regular monitoring of liver function during treatment [9].
- GGTif neededOn a DOAC: liver function before treatment and then at least once a year [1]; edoxaban: regular monitoring beyond one year [4]; amiodarone: regular monitoring of liver function during treatment [9].
- ALPif neededOn a DOAC: liver function before treatment and then at least once a year [1]; edoxaban: regular monitoring beyond one year [4]; amiodarone: regular monitoring of liver function during treatment [9].
- Total bilirubinif neededOn a DOAC: liver function before treatment and then at least once a year [1]; edoxaban: regular monitoring beyond one year [4]; amiodarone: regular monitoring of liver function during treatment [9].
Do not order
- Troponin, CRP, BNP or NT-proBNP, serum digoxin, anti-Xa activity: “as needed” only, no routine measurement at follow-up [2].
Sources (11)
- GUIDE PARCOURS DE SOINS Fibrillation atriale
- HAS - ALD 5 Fibrillation auriculaire
- Agence européenne des médicaments. Eliquis (apixaban) : résumé des caractéristiques du produit, rubriques 4.2 et 4.4.
- Agence européenne des médicaments. Lixiana (édoxaban) : résumé des caractéristiques du produit, rubriques 4.2 et 4.4.
- Agence européenne des médicaments. Pradaxa (dabigatran étexilate) : résumé des caractéristiques du produit, rubrique 4.2.
- Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149(1):e1-e156 : section 4.2.1 (évaluation initiale) et choix de la dose des AOD.
- National Institute for Health and Care Excellence (NICE). Atrial fibrillation: diagnosis and management. NICE guideline NG196, publiée le 27 avril 2021, mise à jour le 30 juin 2021 : recommandations 1.2.2, 1.2.3 et réévaluation de l'anticoagulation.
- Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612-1676.
- ANSM, Base de données publique des médicaments. Résumé des caractéristiques du produit CORDARONE 200 mg, comprimé sécable, rubrique 4.4 (mise à jour du 29/09/2026).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 du 2 juin 2026 : actes 1104 (hémogramme) et 0127 (INR).
- Institut national d'excellence en santé et en services sociaux (INESSS). Fibrillation auriculaire chez l'adulte : guide d'usage optimal de l'anticoagulothérapie. Québec : INESSS ; avril 2019.