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A randomized comparison of two direct oral anticoagulants for patients undergoing cardiac ablation with a contemporary warfarin control arm

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The safety and efficacy of periprocedural use of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) remain unclear. We compared the incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium following AF ablation among patients receiving edoxaban, rivaroxaban, and warfarin and between normal- and low-dose use of edoxaban and rivaroxaban.

Methods

This prospective randomized study included 170 consecutive AF patients. Patients taking DOACs upon admission to our hospital were randomly assigned to an edoxaban group or to a rivaroxaban group. Warfarin was continued in patients receiving warfarin at admission. All patients underwent AF ablation, and cerebral MRI was performed to evaluate asymptomatic cerebral micro-thromboembolism the day after the procedure.

Results

Sixty-one patients were assigned to edoxaban and 63 to rivaroxaban. Warfarin was continued in 46 patients. Although asymptomatic cerebral micro-thromboembolism was detected in 25 patients (16.3%), there were no significant differences among the groups. Hemopericardium occurred in 2 patients (one each in the rivaroxaban and warfarin groups). The incidence of asymptomatic cerebral micro-thromboembolism was higher in the low-dose group (9 patients, 25.7%) than in the normal-dose group (8 patients, 10.0%) for patients prescribed either edoxaban or rivaroxaban (p < 0.05). The proportion of males (88.0%, 69.5%, p < 0.05), history of prior AF ablation (64.0%, 42.2%, p < 0.05), and hypertension (68.0%, 46.1%, p < 0.05) were significantly higher in patients with cerebral thromboembolism.

Conclusions

The incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium in AF ablation was similar among patients using edoxaban, rivaroxaban, and warfarin. However, low doses of DOACs may increase the risk of asymptomatic stroke.

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Abbreviations

AF:

Atrial fibrillation

CAG:

Coronary angiography

CFAE:

Complex fractionated atrial electrogram

DOAC:

Direct oral anticoagulant

DW-MRI:

Diffusion-weighted MRI

MD-CT:

Multi-detector computed tomography

PVI:

Pulmonary vein isolation

SD:

Standard deviation

OR:

Odds ratio

T2W-MRI:

T2-weighted MRI

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Acknowledgments

We thank Clare Cox, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant Number 26461077).

Author information

Author notes

  1. Issei Yoshimoto and Yasuhisa Iriki contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Issei Yoshimoto, Yasuhisa Iriki, Naoya Oketani, Hideki Okui, Hitoshi Ichiki, Masaaki Miyata & Mitsuru Ohishi

  2. Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan

    Ryuichi Maenosono & Fuminori Namino

Authors
  1. Issei Yoshimoto
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  2. Yasuhisa Iriki
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  4. Hideki Okui
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Corresponding author

Correspondence to Naoya Oketani.

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All patients provided written informed consent to participate in this study, and the study protocol was approved by the institutional ethics committee of Kagoshima University Hospital.

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Yoshimoto, I., Iriki, Y., Oketani, N. et al. A randomized comparison of two direct oral anticoagulants for patients undergoing cardiac ablation with a contemporary warfarin control arm. J Interv Card Electrophysiol 60, 375–385 (2021). https://doi.org/10.1007/s10840-020-00732-y

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  • DOI: https://doi.org/10.1007/s10840-020-00732-y

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