Oral anticoagulation regimens
The following 4 DOACs had been prescribed at least 4 weeks before the
ablation: rivaroxaban, apixaban, edoxaban, and dabigatran. 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 [7] or landmark
trials [8-10], the standard doses of apixaban, edoxaban, and
dabigatran were determined as 5 mg BID, 60 mg OD, and 150 mg BID,
respectively. A landmark trial [11] and the guidelines [7]
recommend a 20 mg OD as a standard dose for rivaroxaban. However, based
on the J-ROCKET AF trial [12]
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 patients had a
creatinine clearance of ≤50 ml/min [12]. 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
[7,8]. 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
[7,9]. To date, there is no pre-specified dose-reduction criteria
for dabigatran [7]. 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 [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.