Comparative Safety of Periablation Anticoagulation Strategies for Atrial Fibrillation: Data from a Large Multicenter Study

Abstract

Background There are a variety of periprocedural anticoagulation strategies for atrial fibrillation (AF) ablation, including the use of dabigatran. It is unclear which strategy is superior. Objective To compare the safety and efficacy of anticoagulation with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing ablation of AF at four experienced centers. Methods and Results In this retrospective analysis, 882 patients (mean age: 61 ± 11 years) underwent ablation of AF using uninterrupted warfarin (n = 276), dabigatran (n = 374), or warfarin with heparin bridging (n = 232) for periprocedural anticoagulation. The rate of total complications was 23/276 (8.3%) in the uninterrupted warfarin group, 30/374 (8.0%) in the dabigatran group, and 29/232 (12.5%) in the bridged group (P = 0.15). Major complications were more frequent in the uninterrupted warfarin group 12/276 (4.3%) compared with 3/374 (0.8%) in dabigatran and 6/232 (2.6%) in the bridged group (P = 0.01). The most common major complication was the need for transfusion or occurrence of major bleeding. Minor complications did not differ among the three groups. On multivariate analysis, female gender (odds ratio [OR] 1.93, confidence interval [CI] 1.16–3.19, P = 0.011), bridging heparin (OR 2.13, CI 1.100–3.941, P = 0.016), use of triple antithrombotic therapy (OR 1.77, CI 1.05–2.98, P = 0.033), and prior myocardial infarction (OR 2.40, CI 1.01–5.67, P = 0.046) independently predicted total complications. Conclusions When comparing the use of uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing catheter ablation of AF, dabigatran was not associated with increased risk, major complications were more common in the uninterrupted warfarin group, and after adjustment, warfarin with bridging increased total complications.

Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A retrospective safety analysis

“…Other studies proved the same [12,17]. The use of NOAC became more attractive the later years due to both more experience and resulting better controllability and demonstrated lower bleeding risk in general [9][10][11][12][13][14][15][16][17].…”

“…It is important to investigate whether these patients are more likely to have bleeding complications and derive strategies for prevention. Previous studies were limited to the effects of solely anticoagulants on peri-interventional bleeding risks, vascular damage and pericardial tamponades associated with CA of AF [5,[9][10][11][12][13][14][15][16]. Data on the risk of AAT in patients undergoing CA of AF does not seem to be well studied.…”

How To Manage Oral Anticoagulation Periprocedurally During Ablations And Device Implantations

“…[23] Arshad et al compared the strategy of continuous warfarin vs interrupted warfarin plus bridging vs holding 1 dose of dabigatran preprocedure and restarting that evening. [24] There was no significant difference in bleeding or TE risks between the groups.…”

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

“…Последнюю дозу рива-роксабана обычно назначают за 24-36 ч до ка-тетерного вмешательства [27,[30][31][32]. Сведения о безопасности использования НОАК при абла-ции в данных исследованиях были противоре-чивы, но в целом вероятность развития тромбо-эмболии и риск кровотечения схожи с таковы-ми при непрерывной стратегии приема АВК [33][34][35].…”