Pilot-study: Concentration of direct oral anticoagulants in patients undergoing cardioversion

Anna Gavrilova (Corresponding Author), Jānis Meisters, Anastasija Ņikitina, Gustavs Latkovskis, Inga Urtāne

Research output: Contribution to journalMeeting Abstractpeer-review

Abstract

Background and Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Most patients with AF receive long-term oral anticoagulation to prevent embolic events. For patients undergoing electrical cardioversion, amiodarone as a pre-treatment is commonly administered to increase efficacy of the procedure. The risk of bleeding increases in patients with higher blood levels of direct oral anticoagulant (DOAC), and amiodarone may interfere with DOAC concentrations. The clinical practice still has uncertainty regarding monitoring DOACs in patients with safety issues. This pilot-study aimed to detect patients with higher-than-expected DOAC concentration levels in the blood.

Setting and Method: This cross-sectional study was conducted at Pauls Stradins Clinical University Hospital, Riga, Latvia, from August to December 2022. Irrespective of time since the intake of the drug one blood sample was taken at the hospital to determine DOAC concentration on the day of cardioversion. Functional anti-Xa assays for rivaroxaban and edoxaban (Hyphen Biomed) and anti-IIa assay for dabigatran (Siemens Healthineers) were used. Statistical Package for the Social Sciences (IBM SPSS Statistics 27.0) was used for data analyses. For group comparison, Fisher's Exact Test was applied.

Main outcome measures: DOAC concentration level (ng/mL) in blood sample using chromogenic assays.

Results: A total of 38 patients receiving rivaroxaban (n = 19), dabigatran (n = 6) or edoxaban (n = 13) were involved. In this cohort, DOAC concentration level intervals in blood were 8–480 ng/mL for rivaroxaban, 24–237 ng/mL for dabigatran and 9–481 ng/mL for edoxaban. Seventeen (rivaroxaban n = 10, dabigatran n = 2, and edoxaban n = 5) patients received amiodarone several days before and on the procedure day. Higher-than-expected DOAC concentrations were detected among 3 rivaroxaban and 7 edoxaban users with levels higher than 343 ng/mL and 245 ng/mL as defined in the literature (Dunois C, 2021), respectively. Higher-than-expected concentrations were observed among patients treated with amiodarone: 20% (n = 2/10) vs 11% (n = 1/9) for rivaroxaban (OR = 2.0, p = 1.000) and 100% (n = 5/5) vs 25% (n = 2/8) for edoxaban (OR = 15.0, p = 0.021).

Conclusion: In atrial fibrillation patients receiving amiodaron before scheduled electrical cardioversion, higher-than-expected concentrations of DOACs are commonly found. The interaction of amiodarone seems significant with edoxaban. Larger and more focused real-life studies are warranted to estimate the safe simultaneous use of DOACs with amiodaron and other common medicines in this patient population.
Original languageEnglish
Article numberOR01.3
Pages (from-to)789-790
JournalInternational Journal of Clinical Pharmacy
Volume45
Issue number3
DOIs
Publication statusPublished - May 2023
EventESCP Spring Workshop 2023: Advancing clinical pharmacy and care in diabetes and cardiovascular comorbidities - KAVA Congress Centre, Antwerp, Belgium
Duration: 20 Apr 202321 Apr 2023
https://escpweb.org/escp_events/escp-spring-workshop-2023/

Field of Science*

  • 3.1 Basic medicine
  • 3.2 Clinical medicine

Publication Type*

  • 3.3. Publications in conference proceedings indexed in Web of Science and/or Scopus database

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