Impact of periprocedural anticoagulation therapy on the incidence of silent stroke after atrial fibrillation ablation in patients receiving direct oral anticoagulants: uninterrupted vs. interrupted by one dose strategy

Nagao, Tomoyuki; Suzuki, Hitomi; Matsunaga, Syun; Nishikawa, Yoshinori; Harada, Kazuhiro; Mamiya, Kumiko; Shinoda, Norihiro; Harada, Ken; Kato, Masataka; Marui, Nobuyuki; Amano, Tetsuya; Inden, Yasuya; Murohara, Toyoaki

doi:10.1093/europace/euy224

Cited by 38 publications

(42 citation statements)

References 14 publications

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“…Overall, there were a few minor statistically significant differences, but no clinically meaningful differences in the pre-ACT in the min-Int group compared with those in the Unint group. Previous studies have also reported significant differences in pre-ACT between the minimally interrupted and uninterrupted anticoagulation therapies, 15,16 with the between-group difference reported being larger than that in this study.…”

Section: Complications and Safety Outcomescontrasting

confidence: 72%

“…When pre‐ACT values were compared between the min‐Int and Unint groups, a few minor statistically significant differences were found, but no clinically meaningful differences in the pre‐ACT at each of the four ablation start times and for each of the four DOACs used, as well as for the four DOACs combined, was noted. Two previous studies have examined pre‐ACT values between the minimally interrupted and uninterrupted DOAC anticoagulation therapies . However, these studies did not include the time‐dependent pre‐ACT, prohibiting a specific comparison of our outcomes to the findings of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Dabigatran and apixaban were prescribed twice a day (morning and evening). Rivaroxaban was administered once a day in the morning, rather than in the evening, to maintain a sufficient adherence rate . Edoxaban was prescribed once a day (morning).…”

Section: Methodsmentioning

confidence: 99%

“…Two previous studies have examined pre-ACT values between the minimally interrupted and uninterrupted DOAC anticoagulation therapies. 15,16 However, these studies did not include the time-dependent pre-ACT, prohibiting a specific comparison of our outcomes to the findings of these studies. Overall, there were a few minor statistically significant differences, but no clinically meaningful differences in the pre-ACT in the min-Int group compared with those in the Unint group.…”

Section: Complications and Safety Outcomesmentioning

confidence: 99%

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Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Yamaji

Murakami

Hina

et al. 2019

Cardiovasc electrophysiol

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Background Activated clotting time (ACT)–guided heparinization is used during atrial fibrillation (AF) ablation. Differences in sensitivity to ACT assays have been identified among different direct oral anticoagulants (DOACs). Objective We aimed to examine ACT just before ablation (pre‐ACT) for different ablation start times (9:00, 11:00, 13:00, or 15:00) and ablation safety outcomes in minimally interrupted (min‐Int) and uninterrupted (Unint) DOAC regimens and examine differences in pre‐ACT values among four DOACs. Methods Consecutive patients were randomized into the min‐Int (n = 307) or Unint (n = 277) groups. DOACs examined were apixaban, dabigatran, edoxaban, and rivaroxaban. Results No sequential changes in pre‐ACT values were observed for each DOAC used and for all four DOACs combined in the min‐Int and Unint groups. There was no meaningful difference in pre‐ACT at each ablation start time between the groups. Clinically significant differences in overall pre‐ACT were not obtained between the groups (138 ± 24 vs 142 ± 23 seconds). The pre‐ACT (baseline) value for dabigatran was on average 29 seconds higher than that for the other three DOACs. The min‐Int and Unint groups showed similar thromboembolic (0% vs 0%) and bleeding event rates (major, 1% vs 0%; all, 3.5% vs 2.5%). Conclusion The pre‐ACT did not show a sequential change in the min‐Int and Unint groups. No notable differences in the time‐dependent change in pre‐ACT between the groups were observed. Variations in baseline ACT suggest the need for moderate adjustment of ACT for adequate modification of heparin dose for the other three DOACs. Both regimens provided similar acceptable AF ablation safety outcomes.

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Section: Complications and Safety Outcomescontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Complications and Safety Outcomesmentioning

confidence: 99%

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Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Yamaji

Murakami

Hina

et al. 2019

Cardiovasc electrophysiol

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“…Five studies with a total of 840 UA patients and 938 IA patients were included in the meta-analysis; of these, 3 were randomized trials, [12][13][14] and 2 were observational studies. 15,16 Two identi ed studies were excluded due to lack of comparative data.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Basu‐Ray

Khanra

Kupó

et al. 2020

Preprint

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial fibrillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and efficacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial fibrillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this meta-analysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and five studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events.RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before first heparin bolus was significantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was significantly higher with interrupted anticoagulation (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were significantly more frequent with interrupted anticoagulation (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22; P<.01; I2, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.CONCLUSIONS Uninterrupted anticoagulation during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias

Bawazeer

Alkofide

Alsharafi

et al. 2019

Cochrane Database of Systematic Reviews

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Impact of periprocedural anticoagulation therapy on the incidence of silent stroke after atrial fibrillation ablation in patients receiving direct oral anticoagulants: uninterrupted vs. interrupted by one dose strategy

Cited by 38 publications

References 14 publications

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

Interrupted versus uninterrupted anticoagulation therapy for catheter ablation in adults with arrhythmias

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