Interrupted or Uninterrupted Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

Yang, Panpan; Wang, Chenxi; Ye, Yin-Quan; Huang, Tieqiu; Yang, Shuai; Shen, Wen; Xu, Gaosi; Wu, Qinghua

doi:10.1007/s10557-020-06967-1

Cited by 11 publications

(10 citation statements)

References 39 publications

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“…Only US‐guided venipuncture led to the reduction of MVCs in males, other measures have not resulted in the tangible reduction of MVCs. In contrast to the vast clinical knowledge of lower bleeding rate with the use of uninterrupted oral anticoagulation in CA for AF, 26 no MVC reduction was observed in our analysis. Unfortunately, we do not have the data on the proportion of direct oral anticoagulants and this may be one of the factors.…”

Section: Discussioncontrasting

confidence: 99%

Gender differences in major vascular complications of catheter ablation for atrial fibrillation

Plášek

Wichterle

Peichl

et al. 2021

Cardiovasc electrophysiol

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Aims Catheter ablation (CA) for atrial fibrillation (AF) has a considerable risk of procedural complications. Major vascular complications (MVCs) appear to be the most frequent. This study investigated gender differences in MVCs in patients undergoing CA for AF in a high‐volume tertiary center. Methods A total of 4734 CAs for AF (65% paroxysmal, 26% repeated procedures) were performed at our center between January 2006 and August 2018. Patients (71% males) aged 60 ± 10 years and had a body mass index of 29 ± 4 kg/m2 at the time of the procedure. Radiofrequency point‐by‐point ablation was employed in 96.3% of procedures with the use of three‐dimensional navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MVCs were defined as those that resulted in permanent injury, required intervention, or prolonged hospitalization. Their rates and risk factors were compared between genders. Results A total of 112 (2.4%) MVCs were detected: 54/1512 (3.5%) in females and 58/3222 (1.8%) in males (p < .0001). On multivariate analysis, lower body height was the only risk factor for MVCs in females (p = .0005). On the contrary, advanced age was associated with MVCs in males (p = .006). Conclusion Females have a higher risk of MVCs following CA for AF compared to males. This difference is driven by lower body size in females. Low body height in females and advanced age in males are independent predictors of MVCs. Ultrasound‐guided venipuncture lowered the MVC rate in males.

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Section: Discussioncontrasting

confidence: 99%

Gender differences in major vascular complications of catheter ablation for atrial fibrillation

Plášek

Wichterle

Peichl

et al. 2021

Cardiovasc electrophysiol

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“…Yang et al 48 recently reported that three NOAC strategies (UI‐NOAC, MI‐NOAC [one dose skipped] and completely interrupted NOAC [CI‐NOAC] [24‐hour skipped]) may have similar safety and efficacy in terms of thromboembolism and major bleeding complications. However, CI‐NOAC use significantly increased the risk of total bleeding after AF ablation compared with UI‐NOAC and MI‐NOAC.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining trials compared NOAC (continuous or interrupted) versus VKA (continuous or interrupted). We believe that the literature search of the Yang et al 48 study was not comprehensive as some qualified articles were not included. Third, we additionally assessed SS and found a significant difference between groups.…”

Section: Discussionmentioning

confidence: 99%

“…Third, we additionally assessed SS and found a significant difference between groups. Finally, Yang et al 48 defined CI‐NOAC as withdrawal of NOAC in the morning on the day before the ablation, and some patients were bridged with heparin during the blanking period. This is why we did not include the CI‐NOAC group because of a violation of the inclusion criteria (absence of heparin bridging).…”

Section: Discussionmentioning

confidence: 99%

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Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Mao

Wang

Huang

2020

Pacing Clinical Electrophis

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial brillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and e cacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial brillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this metaanalysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial brillation. METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and ve 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 rst heparin bolus was signi cantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was signi cantly 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 signi cantly more frequent with interrupted anticoagulation (log odds ratio,-0.90; 95% CI,-1.59 to-0.22; P<.01; I 2 , 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. CONCLUSIONS Uninterrupted anticoagulation during atrial brillation 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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“…Thus, DOACs are more convenient for both patients and physicians and are replacing VKAs in general practice, including patients undergoing CAAF. Several clinical trials [27][28][29][30][31][32] and meta-analysis (Table 1) [33][34][35][36][37][38][39][40][41][42] comparing the use of uninterrupted DOAC vs. warfarin therapy for CAAF reported no differences in the incidence of stroke/SE/TIA or minor bleeding events, but DOAC therapy was associated with reduced risk of MBEs, which translated into a significant net clinical benefit. Thus, unless they are contraindicated (i.e., patients with moderateto-severe mitral stenosis and/or mechanical heart valves), uninterrupted OAT with DOACs is preferred to VKAs for S/SE prevention in patients undergoing CAAF [1][2][3].…”

Section: Oral Anticoagulant Therapymentioning

confidence: 99%

Is It Safe (and When) to Stop Oral Anticoagulation After Ablation for Atrial fibrillation? (Do We Have Enough Evidence to Solve the Dilemma?)

Merino

Tamargo

2021

Cardiovasc Drugs Ther

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Interrupted or Uninterrupted Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

Cited by 11 publications

References 39 publications

Gender differences in major vascular complications of catheter ablation for atrial fibrillation

Gender differences in major vascular complications of catheter ablation for atrial fibrillation

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Is It Safe (and When) to Stop Oral Anticoagulation After Ablation for Atrial fibrillation? (Do We Have Enough Evidence to Solve the Dilemma?)

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