The pharmacological properties of the four commercially available DOACs indicated for NVAF (dabigatran, rivaroxaban, apixaban, and edoxaban) are outlined in Table 1. The DOACs vary substantially in pharmacokinetic properties, including dependence on renal excretion, so duration to hold anticoagulation may differ among the agents. In addition, thrombotic risk associated with discontinuation of anticoagulation must be considered. Procedural, as well as patient-related, bleed risks are equally crucial. The following is a summary of current evidence on pre-procedural management of DOACs for EP and catheterization procedures.īoth thromboembolic and bleeding complications pose potentially devastating outcomes thus, risks must be carefully balanced when considering management of pre-procedural anticoagulation. Data are especially limited in patients undergoing electrophysiology (EP) and cardiac catheterization procedures, with various opinions not only on when to hold but also if to continue DOAC therapy through certain procedures. With universal embracement of DOAC usage in NVAF, questions regarding periprocedural management are frequently encountered. Current AF guidelines assign a Class I recommendation for warfarin, dabigatran, rivaroxaban, or apixaban as oral anticoagulant options in patients with NVAF, stating that choice should be individualized based on shared decision-making between the provider and patient. Additionally, DOACs have demonstrated safety and efficacy for long-term oral anticoagulation in patients with NVAF. Standard dosing, lack of required routine laboratory testing, and both minimal dietary and drug interactions compared with traditional vitamin K antagonists appeal to patients and physicians alike. Direct oral anticoagulants (DOACs) have become the foundation for prevention of thromboembolic complications in patients with nonvalvular (NV) atrial fibrillation (AF).
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