Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation
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The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated to be at least equivalent to warfarin for preventing cardiac thromboembolism (TE) in patients with atrial fibrillation (AF). However, there is limited data regarding use around catheter ablation (CA) procedures.
We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation.
Consecutive patients undergoing AF ablation between January 2011 and 6 September 2013 were grouped based on peri-procedural anticoagulation regimen: (1) uninterrupted warfarin with therapeutic INR (WARF), n = 114, (2) dabigatran, n = 89, or (3) rivaroxaban, n = 98. NOACs were held for 24 h (dabigatran) or 36 h (rivaroxaban) prior to the procedure. Heparin infusion was initiated 6 h post-procedure for the NOAC groups; NOACs were resumed the morning after the procedure. Antral PVI was performed with activated clotting time (ACT) maintained >300 s. TE or bleeding complications during ablation and through 30 days were compared.
Three hundred and one patients underwent ablation for paroxysmal (71 %) or persistent (29 %) AF. International Normalization Ratio (INR) for the WARF group was 2.0 ± 0.5. Baseline characteristics were similar among the groups. There were two TE events (asymptomatic cerebral emboli and TIA), and there were 17 bleeding events (large hematoma n = 4; pericardial effusion n = 6; persistent hematuria n = 1; pseudoaneurism/AV fistula n = 6). Of the six pericardial effusions, three required drainage. There was no significant difference in combined TE/bleeding risk among the groups (WARF vs. dabigatran vs. rivaroxaban; 6.2 % vs. 6.7 % vs. 6.0 %; p = 0.82)
In this group of AF patients undergoing CA, use of peri-procedure dabigatran or rivaroxaban compared to uninterrupted warfarin did not lead to an increase in bleeding or TE complications.
- Kannel, W. B., Wolf, P. A., Benjamin, E. J., & Levy, D. (1998). Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. The American Journal of Cardiology, 82, 2N–9N. CrossRef
- Wann, L., Curtis, A., January, C. T., Ellenbogen, K., Lowe, J., Estes, M., et al. (2011). 2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 57(2), 223–242. CrossRef
- Coppens, M., Eikelboom, J., Hart, R., Yusuf, S., Lip, G., Dorian, P., et al. (2013). The CHA2DS2-VASc score identifies those patients with atrial fibrillation and a CHADS2 score of 1 who are unlikely to benefit from oral anticoagulant therapy. European Heart Journal, 34(3), 170–176. CrossRef
- Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., et al. (2009). Dabigitran versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine, 361, 1139–1151. CrossRef
- Patel, M. R., Mahaffey, K. W., Garg, J., the ROCKET AF Steering Committee, for the ROCKET AF Investigators, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England Journal of Medicine, 385(10), 883–891. CrossRef
- Calkins, H., Kuck, K., Cappato, R., Brugada, J., Camm, J., Chen, S., et al. (2012). 2012 HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research. J Interv Card Electrophysiol 33, 171–257.
- Hussein, A. A., Martin, D. O., Saliba, W., Patel, D., Karim, S., Batal, O., et al. (2009 Oct). Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy. Heart Rhythm, 6(10), 1425–1429.
- Fuster, V., Ryden, L., Cannom, D., Crijns, H., Curtis, A., Ellenbogen, K., et al. (2011). 2011 ACCF/AHA/HRS Focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. Circulation, 123, e269–e36. CrossRef
- Lakkireddy, D., Reddy, Y. M., Di Biase, L., et al. (2012). Feasibility and safety of dabigatran versus warfarin for peri-procedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. Journal of the American College of Cardiology, 59, 956–967. CrossRef
- Winkle, R. A., Mead, R. H., Engel, G., Kong, M. H., & Patrawala, R. A. (2012). The use of dabigatran immediately after atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 23, 264–268. CrossRef
- Snipelisky, D., Kauffman, C., Prussak, K., Johns, G., Venkatachalam, K., & Kusumoto, F. (2012 Oct). A comparison of bleeding complications post-ablation between warfarin and dabigatran. Journal of Interventional Cardiac Electrophysiology, 35(1), 29–33.
- Kim, J. S., She, F., Jongnarangsin, K., Chugh, A., Latchamsetty, R., Ghanbari, H., et al. (2013). Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 10(4), 483–489. CrossRef
- Kaiser, D. W., Streur, M. M., Nagarakanti, R., Whalen, S. P., & Ellis, C. R. (2013). Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter. Journal of Interventional Cardiac Electrophysiology, 37(3), 241–247. CrossRef
- Nin, T., Sairaku, A., Yoshida, Y., Kamiya, H., et al. (2013). A randomized controlled trail of dabigatran versus warfarin for periablation anticoagulation in patients undergoing ablation of atrial fibrillation. PACE, 36, 172–179. CrossRef
- Maddox, W., Kay, G. N., Yamada, T., et al. (2013). Dabigatran versus warfarin therapy for uninterrupted oral anticoagulation during atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 24, 861–865. CrossRef
- Bassiouny, M., Saliba, W., Rickard, J., et al. (2013). Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 6, 460–466. CrossRef
- Eitel, C., Koch, J., Sommer, P., John, S., Kircher, S., Bollmann, A., Arya, A., Piorkowski, C., Hindricks, G., (2013).Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace May 22. (Epub ahead of print).
- Lakkireddy, D., Reddy, M., Swarup, V., Baqdunes, M., Mansour, M., Chaloub, F., Ruskin, J., DiBiase, L., Vallakatti, A., Janga, P., Umbarger, L., Sanchez, J., Burkhardt, D., Horton, R., Reddy, V. A, D’Avila, Atkins, D., Bommana, S., Natale, A., (2013) Uninterrupted rivaroxaban vs. warfarin for periprocedural anticoagulation during atrial fibrillation ablation: a multicenter experience. Heart Rhythm. May ;10(5)S240. (Abstract).
- Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation
Journal of Interventional Cardiac Electrophysiology
Volume 40, Issue 1 , pp 33-38
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Atrial fibrillation
- Catheter ablation
- Pulmonary vein isolation
- Industry Sectors
- Author Affiliations
- 1. Division of Cardiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU, San Francisco, CA, 94143, USA