Oral anticoagulants in fragile patients with percutaneous endoscopic gastrostomy and atrial fibrillation: the ORIGAMI pilot investigation

• DOI: 10.23736/s2724-5683.21.05903-2
• Publication Date: 2022-02-15T10:23:13Z
• Authors: Domenico D’AMARIO; Mattia GALLI; Luigi CAPPANNOLI; Francesco CANONICO; Attilio RESTIVO; Alessandra ARCUDI; Roberto SCACCIAVI...; Maria E. RICCIONI; Rocco VERGALLO; Rocco A. MONTONE; Amelia CONTE; Emiliana MELEO; Stefano LANCELLOTTI; Monica SACCO; Massimo ANTONELLI; Felicita ANDREOTTI; Raimondo DE CRIST...; Filippo CREA
• Keywords: Edoxaban; Percutaneous endoscopic gastrostomy

Extensive data support the superior safety without any trade-off in efficacy of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKA) patients with nonvalvular atrial fibrillation, deep venous thrombosis or pulmonary embolism. Whether DOACs may be successfully used treat complex and fragile percutaneous endoscopic gastrostomy (PEG) remains proven. The purpose this pilot study was evaluate feasibility, anticoagulant effect, preliminary safety/efficacy profile edoxaban administered via PEG an indication for long-term anticoagulation.In prospective, single-arm, study, 12 guideline-recommended anticoagulation fibrillation were prospectively enrolled. Crushed at approved doses PEG. Quantitative measures edoxaban's antifactor Xa activity performed steady state. Thromboembolic bleeding events assessed one-month follow-up.Steady state plasma levels therapeutic range all patients; mean concentration 208.5 (±78.6) ng/mL. At one month follow-up, none had suffered a thromboembolic event; developed minor bleeding, died from non-cardiovascular death, owing sudden worsening pre-existing underlying severe condition.In investigation, we report first time that crushed edoxaban, through patients, is feasible, results concentrations, apparently effective safe.