Inr antidote12/26/2023 ![]() Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation.Īmiodarone is used in the treatment of atrial fibrillation, although the FDA has not approved this indication. 6 – 9 In these patients, amiodarone may be used as an adjunct to reduce the frequency of ICD shocks or to control atrial fibrillation in selected highly symptomatic patients. Because implantable cardioverter-defibrillators (ICDs) are more effective than amiodarone in reducing mortality in high-risk patients with previous myocardial infarction, primary treatment should be an ICD. 5 The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent NNT, 23). One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction, 2.4 percent number needed to treat, 42). even after administration of the antidote, significant DOAC concentrations may reappear and lead to the recurrence of bleeding (more commonly after administration of andexanet alfa, less after administration of idarucizumab).Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results.if an antidote is not available, then start substitution therapy and/or hemodialysis (patient on dabigatran). ![]()
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