Comparison of Safety of Left Atrial Catheter Ablation Procedures for Atrial Arrhythmias Under Continuous Anticoagulation With Apixaban Versus Phenprocoumon

Kaess, Bernhard M.; Ammar, Sonia; Reents, Tilko; Dillier, Roger; Lennerz, Carsten; Semmler, Verena; Grebmer, Christian; Bourier, Félix; Buiatti, Alessandra; Kolb, Christof; Deisenhofer, Isabel; Hessling, Gabriele

doi:10.1016/j.amjcard.2014.10.005

Cited by 59 publications

(29 citation statements)

References 17 publications

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“…Leki z grupy NOAC są alternatywą dla warfaryny [478,[761][762][763][764][765]. W obserwacyjnych kohortach pacjentów poddawanych ablacji przezcewnikowej w doświadczonych ośrodkach, u których stosowano nieprzerwane leczenie za pomocą NOAC, nie uzyskano danych wskazujących na niekorzystny wpływ takiego postępowania na bezpieczeństwo leczenia [761,763,766,767]. Wyniki pierwszej kontrolowanej próby klinicznej, w której porównywano nieprzerwane leczenie za pomocą NOAC i VKA u pacjentów poddawanych ablacji AF, do której włączono ok. 200 osób, niedawno opublikowano [768], podobnie jak kilka doniesień z obserwacyjnych baz danych [761,769,770].…”

Section: Leczenie Przeciwzakrzepowe Przed Ablacją Podczas Ablacji I unclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

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Section: Leczenie Przeciwzakrzepowe Przed Ablacją Podczas Ablacji I unclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,402

4,206

View full text Add to dashboard Cite

“…Details of the RFA procedure have been described previously [6,7]. On the evening and the morning of the ablation procedure patients received only 10 mg Rivaroxaban or 2.5 mg Apixaban respectively.…”

Section: Anticoagulation and Radiofrequency Ablationmentioning

confidence: 99%

Effect of the FXa inhibitors Rivaroxaban and Apixaban on platelet activation in patients with atrial fibrillation

Steppich

Dobler

Brendel

et al. 2017

J Thromb Thrombolysis

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Rivaroxaban and Apixaban, increasingly used for stroke prevention in non-valvular atrial fibrillation (AF), might impact platelet reactivity directly or indirectly. By inhibition of Factor Xa (FXa) they preclude not only generation of relevant thrombin amounts but also block signalling of FXa via protease activated receptors. However, weather FXa-inhibition affects platelet haemostasis remains incompletely known. One hundred and twenty-eight patients with AF on chronic anticoagulation with either Rivaroxaban or Apixaban for at least 4 weeks were included in the study. In a time course group (25 on Rivaroxaban, 13 on Apixaban) venous blood samples were taken before NOAC medication intake in the morning as well as 2 and 6 h afterwards. In 90 patients (Rivaroxaban n = 73, Apixaban n = 17) blood samples were drawn during left atrial RFA procedures before as well as 10 and 60 min after the first heparin application (RFA group). Platelet reactivity analyzed by whole blood aggregometry (Multiplate Analyzer, Roche) in response to ADP, Collagen, TRAP and ASPI (arachidonic acid) was not altered by Rivaroxaban or Apixaban neither in the time course nor in the RFA group. Moreover, soluble P-selectin, Thrombospondin, von Willebrand Factor and beta thromboglobulin plasma levels, measured by ELISA, showed no statistically significant changes in both clinical settings for either FXa-inhibitor. The present study fails to demonstrate any significant changes on platelet reactivity in patients with AF under chronic Rivaroxaban or Apixaban medication, neither for trough or peak levels nor in case of a haemostatic activation in vivo as depicted by RFA procedures.

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“…There are low-quality to moderate-quality data showing that therapy with VKAs, including warfarin, acenocoumarol, and phenprocoumon, does not require interruption for minor procedures, as shown in Table 2. These include dental procedures (tooth extraction; root canal), skin procedures (biopsy; skin cancer removal), and cataract surgery [20][21][22][23][24][25][26][27]. The 2012 ACCP Antithrombotic Therapy Guidelines give only weak Grade 2C recommendations for continuing VKA therapy in these specific situations involving minor procedures, as they have been associated with a low risk of bleeding [3].…”

Section: Overall Periprocedural Antithrombotic Strategymentioning

confidence: 99%

Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery

Spyropoulos

AlBadri²,

Sherwood

et al. 2016

Journal of Thrombosis and Haemostasis

161

144

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To cite this article: Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016; 14: 875-85.Summary. The periprocedural management of patients receiving chronic therapy with oral anticoagulants (OACs), including vitamin K antagonists (VKAs) such as warfarin and direct OACs (DOACs), is a common clinical problem. The optimal perioperative management of patients receiving chronic OAC therapy is anchored on four key principles: (i) risk stratification of patient-related and procedure-related risks of thrombosis and bleeding; (ii) the clinical consequences of a thrombotic or bleeding event; (iii) discontinuation and reinitiation of OAC therapy on the basis of the pharmacokinetic properties of each agent; and (iv) whether aggressive management such as the use of periprocedural heparin bridging has advantages for the prevention of postoperative thromboembolism at the cost of a possible increase in bleeding risk. Recent data from randomized trials in patients receiving VKAs undergoing pacemaker/defibrillator implantation or using heparin bridging therapy for elective procedures or surgeries can now inform best practice. There are also emerging data on periprocedural outcomes in the DOAC trials for patients with non-valvular atrial fibrillation. This review summarizes the evidence for the periprocedural management of patients receiving chronic OAC therapy, focusing on recent randomized trials and large outcome studies, to address three key clinical scenarios: (i) can OAC therapy be safely continued for minor procedures or surgeries; (ii) if therapy with VKAs (especially warfarin) needs to be temporarily interrupted for an elective procedure/surgery, is heparin bridging necessary; and (iii) what is the optimal periprocedural management of the DOACs? In answering these questions, we aim to provide updated clinical guidance for the periprocedural management of patients receiving VKA or DOAC therapy, including the use of heparin bridging.

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Comparison of Safety of Left Atrial Catheter Ablation Procedures for Atrial Arrhythmias Under Continuous Anticoagulation With Apixaban Versus Phenprocoumon

Cited by 59 publications

References 17 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Effect of the FXa inhibitors Rivaroxaban and Apixaban on platelet activation in patients with atrial fibrillation

Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery

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