Feasibility and Safety of Uninterrupted Rivaroxaban for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation

• Published in: Journal of the American College of Cardiology Vol. 63; no. 10; pp. 982 - 988
• Main Authors: Lakkireddy, Dhanunjaya, MD, Reddy, Yeruva Madhu, MD, Di Biase, Luigi, MD, PhD, Vallakati, Ajay, MD, Mansour, Moussa C., MD, Santangeli, Pasquale, MD, Gangireddy, Sandeep, MD, Swarup, Vijay, MD, Chalhoub, Fadi, MD, Atkins, Donita, RN, Bommana, Sudharani, MPhil, Verma, Atul, MD, Sanchez, Javier E., MD, Burkhardt, J. David, MD, Barrett, Conor D., MD, Baheiry, Salwa, MD, Ruskin, Jeremy, MD, Reddy, Vivek, MD, Natale, Andrea, MD
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 18-03-2014; Elsevier Limited
• Subjects: Anticoagulants; Cardiac arrhythmia; Cardiology; Cardiovascular; Catheters; Drug therapy; Internal Medicine; periprocedural anticoagulation; radiofrequency ablation; rivaroxaban; warfarin; pulmonary vein antral isolation; PV; rivaroxaban; PVAI; unfractionated heparin; INR; international normalized ratio; CHADS 2; congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke, transient ischemic attack, or thromboembolism; atrial fibrillation; complex fractionated atrial electrograms; UH; CFAE; HAS-BLED; left atrium; CHA 2DS 2VASc; hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly; AF; activated clotting time; transient ischemic attack; TIA; warfarin; pulmonary veins; ACT; LA; TEE; congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke, transient ischemic attack, or thromboembolism, vascular disease; periprocedural anticoagulation; transesophageal echocardiography; radiofrequency ablation; CHADS2; CHA2DS2VASc
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.11.039

Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.