Impact of different dose reduction criteria for anti‐Xa direct oral anticoagulants on bleeding complications: A single center observational study

• Published in: Journal of arrhythmia 2022-06, Vol.38 (3), p.386-394
• Main Authors: Fukaya, Hidehira, Oikawa, Jun, Nakamura, Hironori, Igarashi, Tazuru, Fujiishi, Tamami, Ishizue, Naruya, Yoshizawa, Tomoharu, Satoh, Akira, Kishihara, Jun, Niwano, Shinichi, Ako, Junya
• Format: Article
• Language: English
• Subjects: Ablation; Age; Analysis; Anticoagulants; Anticoagulants (Medicine); anti‐Xa direct oral anticoagulants; Atrial fibrillation; bleeding complications; Catheters; Complications and side effects; Creatinine; Diabetes; dose reduction criteria; Heart failure; Hypertension; Multivariate analysis; Observational studies; Original; Patients; Pharmaceutical industry; Prescriptions; Stroke; Thromboembolism; Transient ischemic attack
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12716

Background Each direct oral anticoagulant (DOAC) has different dose reduction criteria. Here, we evaluated the differences in the doses of three anti‐Xa DOACs and clinical events based on the dose reduction criteria in patients with atrial fibrillation (AF). Methods Consecutive AF patients prescribed with anti‐Xa DOACs [rivaroxaban (Riva), apixaban (Apix), and edoxaban (Edox)] between April 2011 and May 2016 were retrospectively evaluated. The incidences of thromboembolic and bleeding events were evaluated by the end of December 2020, focusing on the dose proportion. Results A total of 786 patients (72 ± 10 years old, 66.9% male) were enrolled in this study [Riva (n = 337), Apix (n = 239), and Edox (n = 210)]. The proportion of reduced dose prescriptions was significantly greater for Edox (79.2%) than Riva (38.7%) or Apix (31.9%). A Kaplan–Meier analysis showed that the incidence of minor bleeding was significantly higher in the Apix than other groups (p