AUTHOR=Pan Yang-Qi , Jin Lu-Shen , Qian Sang , Jiang Ting , Wang Zhe-Ning , Chen Yi-Lian , Qiu Yi-Xuan , Wu Yi-Hao , Fu Jia-Yang , Li Ling , Lin Yuan-Nan , Li Yue-Chun 

TITLE=Twice-daily rivaroxaban after percutaneous left atrial appendage closure for atrial fibrillation

JOURNAL=Frontiers in Pharmacology

VOLUME=15

YEAR=2024

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1344828

DOI=10.3389/fphar.2024.1344828

ISSN=1663-9812

ABSTRACT=<p><bold>Background and aim:</bold> Rivaroxaban is an emerging oral anticoagulant for postoperative anticoagulation after percutaneous left atrial appendage closure (LAAC). Because a once-daily dosing regimen of rivaroxaban causes fluctuations in the drug plasma concentration, we studied the feasibility and safety of twice-daily rivaroxaban as a postoperative anticoagulation regimen for patients with atrial fibrillation (AF) undergoing LAAC.</p><p><bold>Methods:</bold> This study involved patients with AF who underwent LAAC and took rivaroxaban postoperatively. A total of 326 patients who received a standard total dose (15 or 20 mg) of rivaroxaban based on their creatinine clearance rate were divided into the twice-daily (BID) rivaroxaban group (n = 208) and once-daily (QD) rivaroxaban group (n = 118) according to their anticoagulation strategy. Transesophageal echocardiography was recommended at 3–6 months postoperatively to check for device-related thrombosis (DRT). Clinical outcomes were evaluated during postoperative anticoagulation.</p><p><bold>Results:</bold> The median CHA<sub>2</sub>DS<sub>2</sub>-VASc score (4 [3, 5] vs. 4 [3, 5], <italic>p</italic> = 0.28) and HAS-BLED score (2 [2, 3] vs. 2 [2, 3], <italic>p</italic> = 0.48) were not significantly different between the groups. During the anticoagulation period (4.1 ± 0.7 vs. 4.1 ± 0.9 months, <italic>p</italic> = 0.58), 148 (71.2%) patients in the BID group and 75 (63.6%) in the QD group underwent follow-up transesophageal echocardiography. There were no statistically significant differences between the two groups in terms of DRT (1.4% vs. 2.7%, <italic>p</italic> = 0.60), minor bleeding (8.2% vs. 11.0%, <italic>p</italic> = 0.39), thromboembolic events (1.0% vs. 0.8%, <italic>p</italic> = 1.00), major bleeding (0.5% vs. 0.8%, <italic>p</italic> = 1.00), or death.</p><p><bold>Conclusion:</bold> A short course of twice-daily rivaroxaban following LAAC is a feasible alternative regimen with a low rate of major bleeding events, DRT, and thromboembolic events for patients with AF.</p>