Ablation of Atrial Fibrillation Under Therapeutic Warfarin Reduces Periprocedural Complications

Abstract

Background-Observational

Catheter Ablation of Lone Atrial Fibrillation

“…Another strategy is increasingly applied and it consists of continuous warfarin therapy throughout the whole periprocedural period, without interruption. During the procedure, INR is maintained in lower therapeutic range of 2 to 2.5, and application of subcutaneous LMWH in periprocedural period is not necessary [158,160]. The main concern with uninterrupted warfarin strategy is related to possible procedural bleeding.…”

Possibility of Novel Oral Anticoagulants Usage During Ablation in Atrial Fibrillation

“…Частота больших кровотечений у тех, кто получал прерывистую и непрерывную терапию, составила 0,8% и 0.4%, соответственно, а частота перикардиального выпота -0,8% и 0,5%, соответ-ственно [12]. Еще в одном мета-анализе обсерваци-онных исследований было показано, что применение стратегии непрерывного приема варфарина по срав-нению с прерывистой терапией снижало риск ТЭО, не увеличивая риск кровотечений [13].…”

Periprocedural dabigatran anticoagulation for atrial fibrillation ablation: do we have enough information to make a rational decision

“…Comparing only uninterrupted warfarin versus dabigatran by excluding these three studies, the reduction in neurologic events with warfarin was surprisingly attenuated and lost statistical significance. The exclusion of studies using an inferior warfarin strategy with interruption of anticoagulation would have been expected to reveal a larger signal in favor of warfarin [5]. This unexpected result is explained by chance variation due to small number of events, and other differences in methodology and confounding in the excluded studies.…”

“…A major advance has been the acceptance of uninterrupted therapeutic warfarin instead of routine periprocedural bridging with low-molecular weight heparin (LMWH). This has been associated with a significant reduction in embolic events without increasing the rate of vascular and bleeding complications [5].The anticoagulation landscape for patients with nonvalvular AF has changed in the last 3-4 years with the adoption of direct thrombin inhibitor dabigatran and anti-factor Xa agents rivaroxaban and apixaban. Patients on dabigatran considered for AF ablation pose a dilemma for periprocedural management with three potential options.…”

“…A major advance has been the acceptance of uninterrupted therapeutic warfarin instead of routine periprocedural bridging with low-molecular weight heparin (LMWH). This has been associated with a significant reduction in embolic events without increasing the rate of vascular and bleeding complications [5].…”