Anticoagulation Management Pre- and Post Atrial Fibrillation Ablation: A Survey of Canadian Centres

Possibility of Novel Oral Anticoagulants Usage During Ablation in Atrial Fibrillation

“…Методика его ведения разрабатывалась во многих центрах от прерывистого до непрерывного подхода. При прерывистой страте-гии, как правило, варфарин отменяется за 5 дней до аблации, за 3 дня до процедуры начинают исполь-зовать "bridge" терапию с помощью внутривенного гепарина или подкожного низкомолекулярного гепа-рина (НМГ), поскольку как минимум 2 дня уходит на снижение до терапевтического уровня значений МНО при отмене варфарина [9]. Для минимизирова-ния риска кровотечения во время процедуры внутри-венный гепарин отменяется за 4-6 часов до аблации, в то время как последняя доза подкожного НМГ обычно назначается за 12 часов до аблации.…”

Periprocedural Management of New Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

“…The dose of LMWH varies; some centers use full-dose regimens, whereas others use half doses to reduce the risk of bleeding. 4,6 It is unclear whether preprocedure bridging is necessary in patients at low risk of thromboembolism, and acceptable outcomes have been reported even with low-dose LMWH bridging regimens after the ablation. This is not surprising because based on an annualized risk of stroke of 1.5 to 2.8% in low-risk patients, the attributable risk of stroke with an interrupted strategy is probably in the range of 0.004 to 0.008%.…”

“…6 The move to uninterrupted warfarin was prompted by data suggesting that heparin bridging around the time of procedures increases the risk of bleeding. Thus, in a randomized trial comparing interrupted warfarin and heparin bridging with uninterrupted warfarin in patients undergoing pacemaker or cardioverter-defibrillator implantation, the rate of device pocket hematoma formation was 16% and 3.5% with interrupted therapy and uninterrupted warfarin, respectively.…”

“…4 After completion of the procedure, sheaths are removed when the ACT falls to 200 to 250 sec. 4,6 To shorten the time to sheath removal, some centers give protamine sulfate to rapidly reverse the anticoagulant effect of heparin.…”

“…Many centers bridge patients with intravenous heparin or with subcutaneous low-molecularweight heparin (LMWH). 6 Bridging is often initiated 3 days before the procedure, because it takes at least 2 days for the international normalized ratio to fall below the therapeutic range when warfarin is withheld. To minimize the risk of bleeding during the procedure, intravenous heparin is stopped 4 to 6 hours before ablation, whereas the last dose of subcutaneous LMWH is usually administered 12 hours before ablation.…”