Uninterrupted Direct Oral Anticoagulants Without a Change in Regimen for Catheter Ablation for Atrial Fibrillation Is an Acceptable Protocol

Abstract

Background:In patients undergoing catheter ablation (CA) for atrial fibrillation (AF), the use of uninterrupted direct oral anticoagulants (DOACs) is the current protocol. This study evaluated bleeding complications following the uninterrupted use of 4 DOACs in patients undergoing CA for AF without any change in the dosing regimen. Moreover, we assessed differences between once-and twice-daily DOAC dosing in patients undergoing CA for AF who continued on DOACs without any change in the dosing regimen. Methods and Results:This study was a retrospective single-center cohort study of consecutive patients. All patients continued DOACs without interruption or changes to the dosing schedule, even in the case of morning procedures. The primary endpoint was the incidence of major bleeding events within the first 30 days after CA. In all, 710 consecutive patients were included in the study. Bleeding complications were less frequent in the uninterrupted twice-than once-daily DOACs group. However, the incidence of cardiac tamponade across all DOACs was low (0.98%; 7/710), suggesting that uninterrupted DOACs without changes to the dosing regimen may be an acceptable strategy. The rate of total bleeding events, including minor bleeding (12/710; 1.6%), was also satisfactory. Conclusions:Uninterrupted DOACs without any change in dosing regimen for patients undergoing CA for AF is acceptable. Bleeding complications may be less frequent in patients receiving DOACs twice rather than once daily.

Safety and Efficacy of Uninterrupted Oral Anticoagulation in Patients Undergoing Catheter Ablation for Atrial Fibrillation with Different Techniques

“…We observed an incidence of 1.2% of major periprocedural complications represented by embolic events (one periprocedural ischemic stroke and one systemic air embolism). These data are consistent overall with other reports in the literature [4][5][6][7][8][9][10].…”

“…Most major frequent intra-and perioperative complications are either hemorrhagic or thromboembolic, such as vascular access bleeding, pericardial effusion, cardiac tamponade (in 1-3% of cases), TIA (transient ischemic attack), or stroke (1%). In order to minimize the procedure-related thromboembolic risks, it is necessary to maintain the patient on anticoagulant therapy before, during, and after the CA [4][5][6][7][8][9]. During the procedure, the required anticoagulation state is achieved by the administration of unfractionated heparin, ideally prior to or immediately following transseptal puncture, and adjusted to maintain a target activated clotting time (ACT) of 300 s or more.…”