Feasibility and safety of uninterrupted apixaban in patients undergoing radiofrequency ablation for atrial fibrillation

• Published in: Journal of interventional cardiac electrophysiology Vol. 58; no. 1; pp. 35 - 41
• Main Authors: Osaka, Yuki, Ono, Yuichi, Tao, Susumu, Goto, Kentaro, Miyazaki, Toru, Suzuki, Asami, Kurihara, Ken, Otomo, Kenichiro, Hirao, Kenzo
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2020; Springer Nature B.V
• Subjects: Ablation; Anticoagulants; Bleeding; Cardiac arrhythmia; Cardiology; Catheters; Cerebral infarction; Complications; Feasibility studies; Fibrillation; Heparin; Infarction; Intravenous administration; Magnetic resonance imaging; Medical instruments; Medicine; Medicine & Public Health; NMR; Nuclear magnetic resonance; Protamine sulfate; Radio frequency; Radiofrequency ablation; Safety; Thromboembolism; Warfarin; Warfarin; Silent cerebral infarction; Atrial fibrillation; Catheter ablation; Apixaban
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-019-00563-6

Background
An optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during atrial fibrillation (AF) ablation. Limited data are available on the uninterrupted use of apixaban in patients with AF undergoing catheter ablation. This study aimed to evaluate the safety and efficacy of uninterrupted apixaban in patients undergoing radiofrequency ablation for AF. In particular, we evaluated silent cerebral infarction (CI) during radiofrequency catheter ablation of AF.
Methods
This was a prospective and nonrandomized cohort study. A total of 259 consecutive patients who underwent AF ablation were evaluated; 157 patients received apixaban (Api group), and 102 patients received dose-adjusted (PT-INR 2.0-3.0) warfarin (Wf group). All oral anticoagulants were continued throughout the periprocedural period, including the morning of the procedure. Intravenous heparin was administered during the procedure and neutralized by protamine at the end of the procedure. Sixty-one patients underwent magnetic resonance imaging (MRI) after the procedure to evaluate for silent CI.
Results
Mean age was 66 ± 11 years; there were 91 men (73.7%) and 148 cases of paroxysmal AF (57.1%). No symptomatic CI was observed. Silent CI occurred in 6/61 patients (9.8%). No significant difference was observed between the Api group (4/30 patients, 13.3%) and the Wf group (2/31 patients, 6.5%). There was no significant difference regarding major bleeding events between the Api group (1/157 patients, 0.6%) and the Wf group (2/102 patients, 2.0%).
Conclusions
The safety and efficacy of uninterrupted apixaban for patients undergoing AF ablation were equivalent to warfarin for preventing bleeding and thromboembolic complications.