Minimally interrupted novel oral anticoagulant versus uninterrupted vitamin K antagonist during atrial fibrillation ablation

Abstract

Purpose The safety and efficacy of a minimally interrupted novel oral anticoagulant (NOAC) strategy at the time of atrial fibrillation (AF) ablation is uncertain. The purpose of this study was to compare rates of bleeding and thromboembolic events between minimally interrupted NOAC and uninterrupted vitamin K antagonist (VKA) in patients undergoing AF ablation. Methods This was a retrospective single-center cohort study of consecutive patients who underwent AF catheter ablation between January 2013 and April 2017. Endpoints included major bleeding, clinically relevant non-major bleeding and systemic thromboembolic event from the time of ablation through 30 days. Bleeding events were defined by the Bleeding Academic Research Consortium (BARC) and International Society on Thrombosis and Haemostasis (ISTH). Results A total of 637 patients were included in the analysis, 520 patients used uninterrupted VKA and 117 patients minimally interrupted NOAC (dabigatran: n = 68; apixaban: n = 30; rivaroxaban, n = 14; edoxaban, n = 5). The rate of clinically relevant non-major bleeding was lower in the NOAC group in comparison to the VKA group (BARC type 2: 2.6% versus 8.3%, P = 0.03; ISTH: 0% versus 3.8%, P = 0.03). Rates of major bleeding were similar between groups (BARC type 3 to 5: 3.4% versus 4.2%, P = NS; ISTH: 6.0% versus 8.7%, P = NS; for NOAC and VKA groups, respectively). Rates of systemic embolism were 0% with minimally interrupted NOAC, and 0.6% with uninterrupted VKA (P = NS). Conclusions In patients undergoing AF ablation, anticoagulation with minimally interrupted NOAC was associated with fewer clinically relevant non-major bleeding events in comparison with uninterrupted VKA without compromising thromboembolic safety.

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

“…Subsequently, the large randomised ABRIDGE‐J trial showed that there were fewer major bleeding events in the MI‐dabigatran group compared with UI‐VKA without an increase in thromboembolic events 36 . Moreover, recently, a Netherland study also showed MI‐NOAC therapy was associated with fewer clinically relevant non‐major bleeding events compared with UI‐VKA, without compromising thromboembolism‐related safety within 1 month of the AF ablation 37 . In all, the above‐mentioned studies report the outcomes of comparisons between NOACs with no (or minimal) interruption and UI‐VKA, and it is uncertain whether such results can be extrapolated to UI‐NOAC versus MI‐NOAC.…”

Reducing radiation exposure in second-generation cryoballoon ablation without compromising clinical outcome

“…Patients using vitamin K antagonist (VKA) underwent the procedure using uninterrupted anticoagulation with a target international normalized ratio (INR) between 2.0 and 3.0. Patients using non-vitamin-K oral anticoagulants (NOAC) skipped their dose on the morning of the procedure as previously described [ 8 ]. To exclude LA thrombi, all patients underwent transesophageal echocardiogram within 24 h of the procedure.…”

Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation

“…Numerous pieces of research have been conducted on the administration of oral anticoagulation during PVI. The feasibility, efficacy, and safety of DOACs in the context of PVI have been highlighted in particular by four RCTs with a comparable study design [ 72 , 73 , 74 , 75 , 76 ]. Randomised control trials [ 77 , 78 , 79 ], as well as the current European and American Guidelines [ 34 , 80 ], indicate that uninterrupted (or little interrupted) DOACs offer a reliable substitute for a continuous-VKA approach, with a low risk of thromboembolic events and haemorrhage.…”