Impact of Variations in Kidney Function on Nonvitamin K Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Recent Acute Heart Failure
| Autor: | Francisco J. Pastor-Pérez, José M. Andreu-Cayuelas, Alicia Mateo-Martínez, Sergio Manzano-Fernández, Carmen M. Puche, Pedro J. Flores-Blanco, Mariano Valdés, Vanessa Roldán, Gregory Y.H. Lip, Arcadio García-Alberola |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure Pyridones Administration Oral Renal function 030204 cardiovascular system & hematology Antithrombins Dabigatran 03 medical and health sciences 0302 clinical medicine Rivaroxaban Cardio-Renal Syndrome Thromboembolism Internal medicine Atrial Fibrillation medicine Humans Prospective Studies 030212 general & internal medicine Aged Aged 80 and over business.industry Contraindications Anticoagulants Atrial fibrillation General Medicine medicine.disease Stroke Creatinine Heart failure Cardiology Pyrazoles Female Apixaban business Factor Xa Inhibitors medicine.drug |
| Zdroj: | Revista Española de Cardiología (English Edition). 69:134-140 |
| ISSN: | 1885-5857 |
| Popis: | Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure.An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up.Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance60 mL/min or with advanced age (≥ 75 years) would have needed dosage adjustment during follow-up.The need for dosage adjustment of nonvitamin K oral anticoagulants during follow-up is frequent in patients with atrial fibrillation after acute decompensated heart failure, especially among older patients and those with renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation. |
| Databáze: | OpenAIRE |
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