Prothrombotic Responses After Catheter Ablation for Atrial Fibrillation During Uninterrupted Oral Anticoagulant Agent Administration

• Published in: JACC. Clinical electrophysiology Vol. 5; no. 12; pp. 1418 - 1427
• Main Authors: Yanagisawa, Satoshi, Inden, Yasuya, Fujii, Aya, Sakamoto, Yusuke, Tomomatsu, Toshiro, Mamiya, Keita, Okamoto, Hiroya, Shibata, Rei, Murohara, Toyoaki
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2019
• Subjects: atrial fibrillation; catheter ablation; coagulation marker; D-dimer; oral anticoagulant agents; atrial fibrillation; F1+2; OR; AF; PV; AVNRT; D-dimer; catheter ablation; coagulation marker; DOAC; FMC; oral anticoagulant agents
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2019.09.002

The aim of this study was to evaluate the extent of changes in prothrombotic responses after catheter ablation for atrial fibrillation (AF) under uninterrupted oral anticoagulant agent (OAC) administration.
Catheter ablation for AF has a potential risk for prothrombotic activation and silent thromboembolic events.
A total of 814 patients (n = 172 [warfarin], n = 153 [dabigatran], n = 134 [rivaroxaban], and n = 301 [apixaban] patients undergoing AF ablation and a control group of 54 patients undergoing non-AF ablation) were included. Uninterrupted OACs were administered during the procedure in patients with AF. Blood samples were collected the day before and 3 days after the procedure.
At baseline, D-dimer levels were within normal limits (≤1.0 μg/ml) in more than 90% of the patients in all groups. However, after 3 days, this proportion decreased to 67%, 73%, 59%, 68%, and 65% in the warfarin, dabigatran, rivaroxaban, apixaban, and control groups, respectively (p = 0.180). Changes in prothrombin fragment 1+2 levels differed (p < 0.001), whereas fibrin monomer complex levels 3 days after ablation at a trough were equivalent within normal ranges among the groups (p = 0.146). Multivariate analysis revealed that age, CHA2DS2-VASc score, first session, and radiofrequency ablation were independent predictors of increased D-dimer levels after the procedure. Various changes in prothrombotic markers were observed between the warfarin and direct OAC groups after propensity score matching analyses.
The coagulation cascade was activated after catheter ablation for AF under uninterrupted OAC administration. The changes in various prothrombotic markers differed among the OAC groups.
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