Choice of anticoagulant in patients with atrial fibrillation that occurred in the conditions of COVID-19 (clinical case)

The COVID-19 epidemic is accompanied by an increase in the frequency of rhythm disturbances and, in particular, atrial fibrillation. This article is a clinical analysis of a patient whose atrial fibrillation (fluttering) occurred due to an infection. Using the example of patient management, the issues of anticoagulant support for catheter ablation are considered, the algorithm of perioperative management of patients constantly receiving direct oral anticoagulants (DOAC), adopted in the National Medical Research Centre of Cardiology, is given. The reasons for omitting dabigatran before surgery in a patient are discussed, taking into account the dose of injected unfractionated heparin during catheter ablation. The analysis examines the role of COVID-19 in the origin of atrial fibrillation, provides medical literature data on the incidence of atrial fibrillation during the pandemic. It is indicated that the pandemic is accompanied by an increase in the frequency of atrial fibrillation and an increase in the frequency of stroke and death associated with this rhythm disorder. The question of the optimal choice of anticoagulant in a patient with atrial fibrillation that occurred during COVID-19, taking into account the pharmacological properties of DOAC, is considered. It seems that dabigatran has a minimal risk of drug interactions with drugs for the treatment of COVID-19, which are metabolized by cytochrome P-450 and are substrates for P-glycoprotein. In addition, dabigatran has minimal hepatotoxicity among DOAC registered in the Russian Federation. Much attention in case report is paid to the need for the appointment of DOAC after the procedure of catheter ablation in case of restoration of the sinus rhythm. It is emphasized that modern guidelines for managing the risk of stroke during catheter ablation emphasize the need to take anticoagulants for two months. The need for prolonged use of anticoagulants in case of preservation of the sinus rhythm is determined only by the risk of stroke/thromboembolism that the patient has.