Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL* protocol

Article Details

Authors
Teodoro Iturbe-Hernandez MD, Luis García de Guadiana Romualdo MD, Ignacio Gil Ortega MD, Antonio Martínez Francés MD, Olga Meca Birlanga MD, Juan José Cerezo-Manchado MD

Article Type
Original Research

DOI
10.7573/dic.2020-8-3

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Abstract

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.

*The name of this great Carthaginian military general has been chosen for the protocol as a tribute by the authors, as they carry out their healthcare work in Cartagena

Keywords: atrial fibrillation, COVID-19, dabigatran, direct oral anticoagulants, hepatotoxicity.

Citation: Iturbe-Hernandez T, García de Guadiana Romualdo L, Gil Ortega I, Martínez Francés A, Meca Birlanga O, Cerezo- Manchado JJ. 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 2020; 9: 2020-8-3. DOI: 10.7573/dic.2020-8-3

Contributions: All the authors were fully responsible for all the content and editorial decisions, involved in the design, algorithm proposal and preliminary bibliography research. All authors have reviewed, commented on, and approved the final version of the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article and take responsibility for the integrity of the work as a whole.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest related to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/09/dic.2020-8-3-COI.pdf

Acknowledgements: Writing and editorial assistance was provided by Content Ed Net (Madrid, Spain).

Funding declaration: Writing and editorial assistance was supported financially by Boehringer Ingelheim.

Copyright: Copyright © 2020 Iturbe-Hernandez T, García de Guadiana Romualdo L, Gil Ortega I, Martínez Francés A, Meca Birlanga O, Cerezo- Manchado JJ. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Iturbe-Hernandez T, García de Guadiana Romualdo L, Gil Ortega I, Martínez Francés A, Meca Birlanga O, Cerezo-Manchado JJ. https://doi.org/10.7573/dic.2020-8-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0

Article 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

Correspondence: Juan José Cerezo-Manchado, C/ Mezquita, s/n, 30202, Cartagena (Murcia), Spain. jjcerezo@ucam.edu

Provenance: submitted; externally peer reviewed.

Submitted: 4 August 2020; Peer review comments to author: 17 August 2020; Revised manuscript received: 31 August 2020; Accepted: 1 September 2020; Publication date: 18 September 2020.

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