Safety of Novel Oral Anticoagulants Compared With Uninterrupted Warfarin for Catheter Ablation of Atrial Fibrillation

Abstract

Compared with warfarin, periprocedural anticoagulation with dabigatran resulted in fewer minor hemorrhages and total adverse events after AF ablation. Patients anticoagulated with NOACs required larger doses of heparin and took longer to reach the goal ACT compared with patients anticoagulated with warfarin.

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary

“…∗ IC-EOSystemic anticoagulation with warfarin ∗ or a NOAC is recommended for at least 2 months postcatheter ablation of AF.IC-EO[1, 2]Adherence to AF anticoagulation guidelines is recommended for patients who have undergone an AF ablation procedure, regardless of the apparent success or failure of the procedure.IC-EO[5, 6]Decisions regarding continuation of systemic anticoagulation more than 2 months post ablation should be based on the patient's stroke risk profile and not on the perceived success or failure of the ablation procedure.IC-EO[5, 6]In patients who have not been anticoagulated prior to catheter ablation of AF or in whom anticoagulation with a NOAC or warfarin has been interrupted prior to ablation, administration of a NOAC 3 to 5 h after achievement of hemostasis is reasonable postablation.IIaC-EO[372, 376–380]Patients in whom discontinuation of anticoagulation is being considered based on patient values and preferences should consider undergoing continuous or frequent ECG monitoring to screen for AF recurrence.IIbC-EO AF atrial fibrillation, LOE Level of Evidence, NOAC novel oral anticoagulant, TEE transesophageal electrocardiogram, ACT activated clotting time ∗ Time in therapeutic range (TTR) should be > 65% – 70% on warfarin …”

How minimally interrupted direct oral anticoagulants affect intraprocedural anticoagulation during atrial fibrillation ablation? Insights from a Japanese single‐center retrospective study

“…However, the study design in these trials was advantageous for uninterrupted warfarin. Konduru et al, Bassiouny et al, and Armbruster et al compared uninterrupted warfarin with 1‐3 doses of interrupted direct OACs. Since the half‐life of direct OACs is generally within 12 hours, skipping more than two doses are sufficient for negating their anticoagulant effects.…”

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

“…Было доказано, что боль-ным, принимающим препараты АВК, требуют-ся меньшие дозы гепарина, чем тем, кто по-лучал дабигатран или ривароксабан [38]. Неко-торые электрофизиологи вводят первую нагрузочную дозу сразу после венепункции, перед транссептальной пункцией (ТСП) [8,19,21], в то время как другие применяют половину дозы до ТСП, а вторую половину -после [39].…”