Comparison of different oral anticoagulant regimens in patients with atrial fibrillation undergoing ablation or cardioversion

Abstract

INTRODUCTION Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF). OBJECTIVES The aim of the study was to assess the incidence of left atrial appendage (LAA) thrombus and dense spontaneous echo contrast (SEC), as well as to compare the clinical characteristics of patients with AF treated with different anticoagulant regimens. PATIENTS AND METHODS We studied 1033 consecutive patients with AF, who underwent transesophageal echocardiography (TEE) before AF ablation or cardioversion. We excluded 174 patients without any prior oral anticoagulation or who underwent bridging with heparin before TEE. RESULTS In the study group of 859 patients (median age, 61 years; men, 66%), 437 patients (50.9%) received VKAs; 191 (22.2%), dabigatran; 230 (26.8%), rivaroxaban; and 1 patient (0.1%), apixaban. There were no differences in baseline characteristics or the incidence of LAA thrombus (VKAs, 6.9%; NOACs, 5.5%; P = 0.40) and dense SEC (VKAs, 5.3%; NOACs, 3.3%; P = 0.18) between patients on VKAs and those on NOACs. Compared with patients treated with dabigatran, those on rivaroxaban more often had paroxysmal AF, higher ejection fraction, LAA emptying velocity, and platelet count, as well as lower left ventricular end‑diastolic dimension and hematocrit. The frequency of LAA thrombus in patients receiving dabigatran and those receiving rivaroxaban was comparable (6.8% vs 4.4%; P = 0.29), while dense SEC occurred more often in patients treated with dabigatran (5.2% vs 1.7%; P = 0.06). In a logistic regression analysis, none of the oral anticoagulation regimens predicted LAA thrombus in TEE, whereas maximal LAA emptying velocity was the only parameter independently associated with the presence of thrombus. CONCLUSIONS In the studied group of patients with AF, the choice of anticoagulation did not depend on thromboembolic or bleeding risk.

Clinical characteristics and thromboembolic risk of atrial fibrillation patients with and without congestive heart failure. Results from the CRATF study

“…[ 12 ] Nevertheless, despite better pharmacokinetic profile of NOAC, [ 13 – 15 ] in Poland many patients with non-valvular AF still receive VKA instead of NOAC due to the non-reimbursement of the latter. [ 16 , 17 ] In the present analysis, we compare the baseline characteristics of real-life AF patients with and without CHF.…”

Left Atrial Appendage Thrombus Formation Despite Continuous Non-Vitamin K Antagonist Oral Anticoagulant Therapy in Atrial Fibrillation Patients Undergoing Electrical Cardioversion or Catheter Ablation: A Comparison of Dabigatran and Rivaroxaban

“…A reduced NOAC dose was not a predictor of LAAT in patients treated with dabigatran or rivaroxaban. Similarly, Gawalko et al [ 18 ] reported that prior to cardioversion or catheter ablation, 8% of patients treated with dabigatran and 11% of patients treated with rivaroxaban were prescribed reduced doses and did not show an increased risk of LAAT. In our study, 26% of patients constituted those from the study of Gawalko et al [ 18 ].…”

Przywracanie rytmu zatokowego u pacjentów z migotaniem przedsionków leczonych doustnymi antykoagulantami niebędącymi antagonistami witaminy K jest bezpieczne bez przezprzełykowego badania echokardiograficznego — doniesienie wstępne

“…Gawałko et al [9] in a group of 859 patients showed that NOACs were used in 49% of patients undergoing elective cardioversion or ablation due to AF. Fredriksen et al [10] in a study of 2,150 patients hospitalised for elective cardioversion between 2011 and 2016 showed that the percentage of patients treated with NOACs was lower than in the present study, and was 32%.…”