Residual anticoagulation activity in atrial fibrillation patients with temporary interrupted direct oral anticoagulants: Comparisons across 4 drugs

Abstract

BackgroundAtrial fibrillation (AF) ablation with minimally interrupted direct oral anticoagulants (DOACs) predominates, possibly raising concern about their remaining activity during the procedure. We aimed to examine residual activities of 4 different DOACs. MethodsThe serum DOAC concentration and anti-factor Χa activity were measured 3 and 24 h after the last intake in patients undergoing AF ablation who were treated with rivaroxaban, apixaban, edoxaban, or dabigatran. ResultsThe reduction in the apixaban concentration between the 2 blood sampling time points (N = 32, mean ± SD, −67.7 ± 14.8% [231.6 ± 93.1 to 71.9 ± 31.8 ng/mL]) was smaller than that for rivaroxaban (N = 28, −83.6 ± 10.9% [234.2 ± 96.6 to 34.3 ± 19.8 ng/mL]; P < 0.001) and dabigatran (N = 20, −90.7 ± 7.3% [135.3 ± 68.3 to 12.6 ± 10.6 ng/mL]; P < 0.001), with its greatest value measured 24 h after the last intake in the apixaban group. The decrease in the anti-factor Χa activity was also smaller in the patients with apixaban (−73.8 ± 12.7%) than with rivaroxaban (−87.9 ± 7.9%; P < 0.001) and edoxaban (N = 22, −81.9 ± 15.2%; P = 0.049), and its remaining activity 24 h after the last dose was the highest in the apixaban group. A serum DOAC concentration measured 24 h after the last dose of >30 ng/mL was seen in 41 (51.3%) patients with rivaroxaban, apixaban, or dabigatran, and it was independently associated with apixaban versus rivaroxaban (odds ratio 5.0; P = 0.01) and apixaban versus dabigatran (odds ratio 74.0; P < 0.001). ConclusionThe pattern of drug elimination from blood may vary depending on DOACs, and their residual activity may not be negligible even 24 h after the last intake.