Clinical outcomes of off-label underdosing of direct oral anticoagulants after ablation for atrial fibrillation: Subanalysis of the af frontier ablation registry

Yuji Wakamatsu, Koichi Nagashima, Ryuta Watanabe, Masaru Arai, Katsuaki Yokoyama, Naoya Matsumoto, Takayuki Otsuka, Shinya Suzuki, Akio Hirata, Masato Murakami, Mitsuru Takami, Masaomi Kimura, Hidehira Fukaya, Shiro Nakahara, Takeshi Kato, Hiroshi Hayashi, Yu Ki Iwasaki, Wataru Shimizu, Ikutaro Nakajima, Tomoo HaradaJunjiroh Koyama, Ken Okumura, Michifumi Tokuda, Teiichi Yamane, Kojiro Tanimoto, Yukihiko Momiyama, Noriko Nonoguchi, Kyoko Soejima, Koichiro Ejima, Nobuhisa Hagiwara, Masahide Harada, Kazumasa Sonoda, Masaru Inoue, Koji Kumagai, Hidemori Hayashi, Yoshinao Yazaki, Kazuhiro Satomi, Yuji Watari, Yasuo Okumura

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Direct oral anticoagulants (DOACs) are sometimes prescribed at off-label under-doses for patients who have undergone ablation for atrial fibrillation (AF). This practice may be an attempt to balance the risk of bleeding against that of stroke or AF recurrence. We examined outcomes of 1163 patients who continued use of a DOAC after ablation. The patients were enrolled in a large (3530 patients) multicenter registry in Japan. The study patients were classified as 749 (64.4%) appropriate standard-dose DOAC users, 216 (18.6%) off-label under-dose DOAC users, and 198 (17.0%) appropriate low-dose DOAC users. Age and CHA2DS2-VASc scores differed significantly between DOAC dosing regimens, with patients given an appropriate standard-dose being significantly younger (63.3 ± 9.4 versus 64.8 ± 9.5 versus 73.2 ± 6.8 years, P < 0.0001) and lower (2.1 ± 1.5 versus 2.4 ± 1.6 versus 3.4 ± 1.4, P < 0.0001) than those given an off-label under-dose or an appropriate low-dose. During the median 19.0-month follow-up period, the AF recurrence rate was similar between the appropriate standard-dose and off-label under-dose groups but relatively low in the appropriate low-dose group (42.5% versus 41.2% versus 35.4%, P = 0.08). Annualized rates of thromboembolic events, major bleeding, and death from any cause were 0.47%, 0.70%, and 0.23% in the off-label under-dose group, while those rates were 0.74%, 0.73%, and 0.65% in the appropriate standard-dose, and 1.58%, 2.12%, and 1.57% in the appropriate low-dose groups. In conclusion, the clinical adverse event rates for patients on an off-label under-dose DOAC regimen after ablation, predicated on careful patient evaluations, was not high as seen with that of patients on a standard DOAC dosing regimen.

Original languageEnglish
Pages (from-to)1165-1173
Number of pages9
JournalInternational heart journal
Volume61
Issue number6
DOIs
Publication statusPublished - 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Clinical outcomes of off-label underdosing of direct oral anticoagulants after ablation for atrial fibrillation: Subanalysis of the af frontier ablation registry'. Together they form a unique fingerprint.

Cite this