Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
| Autor: | Kazuyoshi Hina, Shigeshi Kamikawa, Issei Komatsubara, Shozo Kusachi, Hiroshi Kawamura, Takashi Murakami, Hirosuke Yamaji, Shunichi Higashiya, Masaaki Murakami |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Vitamin K Dose medicine.drug_class medicine.medical_treatment Activated clotting time Administration Oral Catheter ablation 030204 cardiovascular system & hematology Perioperative Care Dabigatran 03 medical and health sciences 0302 clinical medicine Internal medicine catheter ablation Atrial Fibrillation medicine non-vitamin K antagonist oral anticoagulant Humans 030212 general & internal medicine pulmonary vein isolation Aged Retrospective Studies Aged 80 and over Pharmacology Rivaroxaban medicine.diagnostic_test business.industry Anticoagulants Atrial fibrillation Perioperative Middle Aged Vitamin K antagonist medicine.disease follow-up studies Treatment Outcome Anesthesia Cardiology Original Article Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of Cardiovascular Pharmacology |
| ISSN: | 0160-2446 |
| Popis: | Background Some patients with atrial fibrillation (AF) received underdoses of non-vitamin K antagonist oral anticoagulants (NOACs) in the real world. Underdosing is defined as administration of a dose lower than the manufacturer recommended dose. Objectives To identify the efficacy and safety of underdosing NOACs as perioperative anticoagulation for atrial fibrillation ablation. Methods We retrospectively analyzed patients who received rivaroxaban or dabigatran etexilate according to dosage: adjusted low dosage (reduced by disturbed renal function; n = 30), underdosage (n = 307), or standard dosage (n = 683). Non-vitamin K antagonist oral anticoagulants and dosing decisions were at the discretion of treating cardiologists. Results Patients who received underdosed NOACs were older, more often female, and had lower body weight and lower renal function than those who received standard dosages. Activated clotting time at baseline in patients who received adjusted low dosage or underdosages was slightly longer than that in patients receiving standard dosages (156 ± 23, 151 ± 224, and 147 ± 24 seconds, respectively). Meaningful differences were not observed in other coagulation parameters. Adjusted low-, under-, and standard-dosing regimens did not differ in perioperative thromboembolic complications (0/30, 0.0%; 1/307, 0.3%; and 0/683, 0%, respectively) or major (0/30, 0.0%; 2/307, 0.6%; 3/683, 0.4%) and minor (1/30, 3.3%; 13/307, 4.2%; 25/683, 3.6%) bleeding episodes. When comparisons were performed for each NOAC, similar results were observed. Conclusions With consideration of patient condition, age, sex, body weight, body mass index, and renal function, underdosing NOACs was effective and safe as a perioperative anticoagulation therapy for atrial fibrillation ablation. The therapeutic range of NOACs is potentially wider than manufacturer recommendations. |
| Databáze: | OpenAIRE |
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