Oral anticoagulation regimens
The following 4 DOACs had been prescribed at least 4 weeks before the
ablation: apixaban, dabigatran, edoxaban, and rivaroxaban. The choice of
the DOAC was left to the discretion of each referring physician. On the
basis of the current guidelines on the use of DOACs [10] or landmark
trials [11-13], the standard doses of apixaban, dabigatran, and
edoxaban were determined as 5 mg BID, 150 mg BID, and 60 mg OD,
respectively. A landmark trial [14] and the guidelines
[10] recommend a 20 mg OD as a
standard dose for rivaroxaban. However, based on the J-ROCKET AF trial
[15]
that included only Japanese patients, its Japan-specific standard dose
of 15 mg OD predominated in Japan. The rivaroxaban dose was reduced to
10 mg OD if the patients had a
creatinine clearance of ≤50 ml/min [15]. For apixaban, the reduced
dose of 2.5 mg BID was given if patients had 2 of the following 3
factors: age ≥80 years, creatinine ≥1.5 mg/dL, and body weight ≤60 kg
[10,11]. To date, there is no pre-specified dose-reduction criteria
for dabigatran [10]. In the present study, we considered it an
appropriate dose reduction if dabigatran 110 mg BID was prescribed in
the patients who were older than 80 years or had a history of massive
bleeding [16]. Patients received a lower edoxaban dose of 30 mg OD
if they had a creatinine clearance of ≤50 ml/min or body weight ≤60 kg
[10,13]. Patients with OD or BID dosing regimens were instructed to
take their total or morning dose, respectively, with breakfast. Patients
with BID dosing regimens were encouraged to take the evening dose at
dinner. On the procedural day, the normal daily dose was not taken until
the post-procedural evening in patients with OD dose regimens. The
morning dose on the procedural day was skipped, and the evening dose was
taken on the post-procedural evening as usual in patients with BID
dosing regimens. In the patients prescribed with any antiplatelets, they
were withheld for at least 7 days before the procedure. A bridging
therapy with heparin was not applied.