title: Impact of Variations in Kidney Function on Nonvitamin K Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Recent Acute Heart Failure.
abstract: OBJECTIVE
  Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure.
  
  
  METHODS
  An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up.
  
  
  RESULTS
  Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance < 60 mL/min or with advanced age (≥ 75 years) would have needed dosage adjustment during follow-up.
  
  
  CONCLUSIONS
  The need for dosage adjustment of nonvitamin K oral anticoagulants during follow-up is frequent in patients with atrial fibrillation after acute decompensated heart failure, especially among older patients and those with renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Andreu-Cayuelas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pastor-Pérez
authors.affiliation: Laboratorio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Puche
authors.affiliation: Servicio de Cardiología, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Mateo-Martínez
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Arcadio
authors.initials: A
authors.lastname: García-Alberola
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Flores-Blanco
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain. Electronic address: sergiomanzanofernandez@gmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D000991:Antithrombins / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D059347:Cardio-Renal Syndrome / Q000150:complications* / Q000503:physiopathology; D000075202:Contraindications; D003404:Creatinine / Q000378:metabolism; D000069604:Dabigatran / Q000008:administration & dosage; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D000069552:Rivaroxaban / Q000008:administration & dosage; D020521:Stroke / Q000503:physiopathology / Q000517:prevention & control; D013923:Thromboembolism / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D003404:Creatinine; D000069604:Dabigatran
keywords: Anticoagulantes; Anticoagulants; Atrial fibrillation; Dosing; Fibrilación auricular; Función renal; Heart failure; Insuficiencia cardiaca; Posología; Renal function