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Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation

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 u...

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Autores principales: Yamaji, Hirosuke, Murakami, Takashi, Hina, Kazuyoshi, Higashiya, Shunichi, Kawamura, Hiroshi, Murakami, Masaaki, Kamikawa, Shigeshi, Komatsubara, Issei, Kusachi, Shozo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Cardiovascular Pharmacology 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295475/
https://www.ncbi.nlm.nih.gov/pubmed/28170360
http://dx.doi.org/10.1097/FJC.0000000000000448
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author Yamaji, Hirosuke
Murakami, Takashi
Hina, Kazuyoshi
Higashiya, Shunichi
Kawamura, Hiroshi
Murakami, Masaaki
Kamikawa, Shigeshi
Komatsubara, Issei
Kusachi, Shozo
author_facet Yamaji, Hirosuke
Murakami, Takashi
Hina, Kazuyoshi
Higashiya, Shunichi
Kawamura, Hiroshi
Murakami, Masaaki
Kamikawa, Shigeshi
Komatsubara, Issei
Kusachi, Shozo
author_sort Yamaji, Hirosuke
collection PubMed
description 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.
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spelling pubmed-52954752017-02-15 Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation Yamaji, Hirosuke Murakami, Takashi Hina, Kazuyoshi Higashiya, Shunichi Kawamura, Hiroshi Murakami, Masaaki Kamikawa, Shigeshi Komatsubara, Issei Kusachi, Shozo J Cardiovasc Pharmacol Original Article 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. Journal of Cardiovascular Pharmacology 2017-02 2016-11-21 /pmc/articles/PMC5295475/ /pubmed/28170360 http://dx.doi.org/10.1097/FJC.0000000000000448 Text en Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Yamaji, Hirosuke
Murakami, Takashi
Hina, Kazuyoshi
Higashiya, Shunichi
Kawamura, Hiroshi
Murakami, Masaaki
Kamikawa, Shigeshi
Komatsubara, Issei
Kusachi, Shozo
Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title_full Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title_fullStr Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title_full_unstemmed Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title_short Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation
title_sort safety and efficacy of underdosing non-vitamin k antagonist oral anticoagulants in patients undergoing catheter ablation for atrial fibrillation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295475/
https://www.ncbi.nlm.nih.gov/pubmed/28170360
http://dx.doi.org/10.1097/FJC.0000000000000448
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