Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation

• Published in: Journal of interventional cardiac electrophysiology Vol. 40; no. 1; pp. 33 - 38
• Main Authors: Stepanyan, Gevorg, Badhwar, Nitish, Lee, Randall J., Marcus, Gregory M., Lee, Byron K., Tseng, Zian H., Vedantham, Vasanth, Olgin, Jeffrey, Scheinman, Melvin, Gerstenfeld, Edward P.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-06-2014; Springer Nature B.V
• Subjects: Aged; Anticoagulants - therapeutic use; Antithrombins - therapeutic use; Atrial Fibrillation - surgery; Benzimidazoles - therapeutic use; beta-Alanine - analogs & derivatives; beta-Alanine - therapeutic use; Cardiology; Catheter Ablation; Dabigatran; Factor Xa Inhibitors - therapeutic use; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morpholines - therapeutic use; Pulmonary Veins - surgery; Retrospective Studies; Rivaroxaban; Thiophenes - therapeutic use; Thromboembolism - prevention & control; Warfarin - therapeutic use; Stroke; Anticoagulation; Atrial fibrillation; Catheter ablation; Pulmonary vein isolation
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-014-9888-9

Background
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.
Objective
We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation.
Methods
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.
Results
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)
Conclusions
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.