Residual anticoagulation activity in atrial fibrillation patients with temporary interrupted direct oral anticoagulants: Comparisons across 4 drugs

Atrial fibrillation (AF) ablation with minimally interrupted direct oral anticoagulants (DOACs) predominates, possibly raising concern about their remaining activity during the procedure. We aimed to examine residual activities of 4 different DOACs.The serum DOAC concentration and anti-factor Χa activity were measured 3 and 24 h after the last intake in patients undergoing AF ablation who were treated with rivaroxaban, apixaban, edoxaban, or dabigatran.The reduction in the apixaban concentration between the 2 blood sampling time points (N = 32, mean ± SD, -67.7 ± 14.8% [231.6 ± 93.1 to 71.9 ± 31.8 ng/mL]) was smaller than that for rivaroxaban (N = 28, -83.6 ± 10.9% [234.2 ± 96.6 to 34.3 ± 19.8 ng/mL]; P < 0.001) and dabigatran (N = 20, -90.7 ± 7.3% [135.3 ± 68.3 to 12.6 ± 10.6 ng/mL]; P < 0.001), with its greatest value measured 24 h after the last intake in the apixaban group. The decrease in the anti-factor Χa activity was also smaller in the patients with apixaban (-73.8 ± 12.7%) than with rivaroxaban (-87.9 ± 7.9%; P < 0.001) and edoxaban (N = 22, -81.9 ± 15.2%; P = 0.049), and its remaining activity 24 h after the last dose was the highest in the apixaban group. A serum DOAC concentration measured 24 h after the last dose of >30 ng/mL was seen in 41 (51.3%) patients with rivaroxaban, apixaban, or dabigatran, and it was independently associated with apixaban versus rivaroxaban (odds ratio 5.0; P = 0.01) and apixaban versus dabigatran (odds ratio 74.0; P < 0.001).The pattern of drug elimination from blood may vary depending on DOACs, and their residual activity may not be negligible even 24 h after the last intake.