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Early Experience of Novel Oral Anticoagulants in Catheter Ablation for Atrial Fibrillation: Efficacy and Safety Comparison to Warfarin
Yonsei Medical Journal ; : 342-349, 2016.
Article in English | WPRIM | ID: wpr-147356
ABSTRACT

PURPOSE:

Compared with warfarin, novel oral anticoagulants (NOACs) are convenient to use, although they require a blanking period immediately before radiofrequency catheter ablation for atrial fibrillation (AF). We compared NOACs and uninterrupted warfarin in the peri-procedural period of AF ablation. MATERIALS AND

METHODS:

We compared 141 patients treated with peri-procedural NOACs (72% men; 58+/-11 years old; 71% with paroxysmal AF) and 281 age-, sex-, AF type-, and history of stroke-matched patients treated with uninterrupted warfarin. NOACs were stopped 24 hours before the procedure and restarted on the same procedure day after hemostasis was achieved.

RESULTS:

We found no difference in the CHA2DS2-VASc (p=0.376) and HAS-BLED scores (p=0.175) between the groups. The preprocedural anticoagulation duration was significantly shorter in the NOAC group (76.3+/-110.7 days) than in the warfarin group (274.7+/-582.7 days, p<0.001). The intra-procedural total heparin requirement was higher (p<0.001), although mean activated clotting time was shorter (350.0+/-25.0 s vs. 367.4+/-42.9 s, p<0.001), in the NOAC group than in the warfarin group. There was no significant difference in thromboembolic events (1.4% vs. 0%, p=0.111) or major bleeding (1.4% vs. 3.9%, p=0.235) between the NOAC and warfarin groups. Minor stroke occurred in two cases within 10 hours of the procedure (underlying CHA2DS2-VASc scores 0 and 1) in the NOAC group.

CONCLUSION:

Pre-procedural anticoagulation duration was shorter and intra-procedural heparin requirement was higher with NOAC than with uninterrupted warfarin during AF ablation. Although the peri-procedural thromboembolism and bleeding incidences did not differ, minor stroke occurred in two cases in the NOAC group.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Postoperative Complications / Atrial Fibrillation / Thromboembolism / Warfarin / Heparin / Incidence / Follow-Up Studies / Treatment Outcome / Catheter Ablation / Stroke Type of study: Incidence study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Language: English Journal: Yonsei Medical Journal Year: 2016 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Postoperative Complications / Atrial Fibrillation / Thromboembolism / Warfarin / Heparin / Incidence / Follow-Up Studies / Treatment Outcome / Catheter Ablation / Stroke Type of study: Incidence study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Language: English Journal: Yonsei Medical Journal Year: 2016 Type: Article