Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol
Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BioExcel Publishing Ltd
2020-09-01
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| Series: | Drugs in Context |
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| Online Access: | https://www.drugsincontext.com/dabigatran-the-oral-anticoagulant-of-choice-at-discharge-in-patients-with-non-valvular-atrial-fibrillation-and-covid-19-infection-the-anibal-protocol |
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| author | Teodoro Iturbe-Hernandez Luis García de Guadiana Romualdo Ignacio Gil Ortega Antonio Martínez Francés Olga Meca Birlanga Juan José Cerezo-Manchado |
| author_facet | Teodoro Iturbe-Hernandez Luis García de Guadiana Romualdo Ignacio Gil Ortega Antonio Martínez Francés Olga Meca Birlanga Juan José Cerezo-Manchado |
| author_sort | Teodoro Iturbe-Hernandez |
| collection | DOAJ |
| description | Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality. Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients. Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection. Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists. However, oral anticoagulants should only be prescribed after the consideration of drug–drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia. Not all anticoagulants have the same risk of hepatotoxicity; dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity. Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent. Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection. In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated. In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented. |
| first_indexed | 2024-12-20T17:20:44Z |
| format | Article |
| id | doaj.art-7be5e90889734b299055999c835923a4 |
| institution | Directory Open Access Journal |
| issn | 1740-4398 1740-4398 |
| language | English |
| last_indexed | 2024-12-20T17:20:44Z |
| publishDate | 2020-09-01 |
| publisher | BioExcel Publishing Ltd |
| record_format | Article |
| series | Drugs in Context |
| spelling | doaj.art-7be5e90889734b299055999c835923a42022-12-21T19:31:50ZengBioExcel Publishing LtdDrugs in Context1740-43981740-43982020-09-01911210.7573/dic.2020-8-3Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocolTeodoro Iturbe-HernandezLuis García de Guadiana RomualdoIgnacio Gil OrtegaAntonio Martínez FrancésOlga Meca BirlangaJuan José Cerezo-ManchadoAtrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality. Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients. Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection. Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists. However, oral anticoagulants should only be prescribed after the consideration of drug–drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia. Not all anticoagulants have the same risk of hepatotoxicity; dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity. Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent. Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection. In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated. In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented.https://www.drugsincontext.com/dabigatran-the-oral-anticoagulant-of-choice-at-discharge-in-patients-with-non-valvular-atrial-fibrillation-and-covid-19-infection-the-anibal-protocolatrial fibrillationcovid-19dabigatrandirect oral anticoagulantshepatotoxicity |
| spellingShingle | Teodoro Iturbe-Hernandez Luis García de Guadiana Romualdo Ignacio Gil Ortega Antonio Martínez Francés Olga Meca Birlanga Juan José Cerezo-Manchado Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol Drugs in Context atrial fibrillation covid-19 dabigatran direct oral anticoagulants hepatotoxicity |
| title | Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol |
| title_full | Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol |
| title_fullStr | Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol |
| title_full_unstemmed | Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol |
| title_short | Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol |
| title_sort | dabigatran the oral anticoagulant of choice at discharge in patients with non valvular atrial fibrillation and covid 19 infection the anibal protocol |
| topic | atrial fibrillation covid-19 dabigatran direct oral anticoagulants hepatotoxicity |
| url | https://www.drugsincontext.com/dabigatran-the-oral-anticoagulant-of-choice-at-discharge-in-patients-with-non-valvular-atrial-fibrillation-and-covid-19-infection-the-anibal-protocol |
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