Dabigatran in patients with atrial fibrillation after COVID-19 hospitalization: an update of the ANIBAL* protocol

Drugs in Context

article

Juan José Cerezo-Manchado¹  Olga Meca Birlanga²  Luis García de Guadiana Romualdo³  Ignacio Gil-Ortega⁴  Antonio Martínez Francés¹  Teodoro Iturbe-Hernandez¹ 

[1] Department of Hematology, Hospital Clínico Universitario Santa Lucía;Department of Pneumology, Hospital Clínico Universitario Santa Lucía;Laboratory Department, Hospital Clínico Universitario Santa Lucía;Department of Cardiology, Hospital Clínico Universitario Santa Lucía

关键词: Atrial fibrillation;    COVID-19;    dabigatran;    direct oral anticoagulants;    hepatotoxicity;    MAFLD;    metabolic syndrome;   

DOI  :  10.7573/dic.2021-9-4

学科分类：社会科学、人文和艺术（综合）

来源: C S F Medical Communications Ltd.

【 摘 要 】

COVID-19 increases the risk of atrial fibrillation (AF) andthrombotic complications, particularly in severe cases, leadingto higher mortality rates. Anticoagulation is the cornerstoneto reduce thromboembolic risk in patients with AF. Consideringthe risk of hepatotoxicity in patients with severe COVID-19as well as the risk of drug–drug interactions, drug-inducedhepatotoxicity and bleeding, the ANIBAL protocol wasdeveloped to facilitate the anticoagulation approach atdischarge after COVID-19 hospitalization. However, since thepublication of the original algorithm, relevant changes haveoccurred. First, treatment of COVID-19 pneumonia has beenmodified with the use of dexamethasone or remdesivir duringthe first week in patients that require oxygen therapy, andof dexamethasone and/or tocilizumab or baricitinib duringthe second week in patients that necessitate supplementaryoxygen or with a high inflammation state, respectively.On the other hand, metabolic syndrome is common inpatients with AF as well as metabolic-associated fatty liverdisease, and this could negatively impact the prognosis ofpatients with COVID-19, including high transaminase levels in patients treated with immunomodulators. The EHRAguidelines update also introduce some interesting changesin drug–drug interaction patterns with the reduction of thelevel of the interaction with dexamethasone, which is ofparamount importance in this clinical context. Consideringthe new information, the protocol, named ANIBAL II, hasbeen updated. In this new protocol, the anticoagulant ofchoice in patients with AF after COVID-19 hospitalizationis provided according to three scenarios: with/withoutdexamethasone treatment at discharge and normal hepaticfunction, transaminases ≤2 times the upper limit of normal, ortransaminases >2 times the upper limit of normal.

【 授权许可】

CC BY-NC-ND