Feasibility and safety of three periprocedure anticoagulation therapy in patients over 75 years ;undergoing radiofrequency ablation for atrial ifbrillation / 中国介入心脏病学杂志

ABSTRACT

Objective To observe the safety and efficacy of different periprocedural anticoagulation strategies in patients undergoing catheter ablation of atrial ifbrillation. Methods Eighty-five patients aged over 75 undergoing catheter ablation of atrial fibrillation from Jul 2011 to Nov 2013 were enrolled. They all took warfarin and transesophageal echocardiograms were performed to rule out left atrium appendage thrombus before ablation. They were divided into 3 groups. In Group 1 (30 cases), warfarin was stopped and bridged with low molecular weight heparin (LMWH) 3 days before procedure and LMWH bridging followed by warfarin alone after procedure. In Group 2 (32 cases), warfarin was continued during periprocedural period. In Group 3 (23 cases), Dabigatran or Rivaroxaban alone was used 4 hours after procedure respectively. Unfractionated heparin was used during procedure in all three groups. These three anticoagulation strategies were compared in bleeding, embolism events and other complications during 3-month follow-up. Results In Group 1, there were 1 new-onset ischemic stroke during hospitalization, 7 lower extremity hematomas, 1 subdural hemorrhage during 3-month follow-up and 6 minor bleeding events. In Group 2, there were 4 lower extremity hematomas and 4 minor bleeding events during 3-month follow-up. As for Group 3, only 2 lower extremity hematomas during hospitalization was observed in each without any minor bleeding events during follow-up. Conclusions Catheter ablation in elderly atrial ifbrillation patients was safe and effective in general. Compared with traditional anticoagulation strategy, continuing warfarin or novel oral anticoagulants could reduce bleeding complications without increasing thromboembolism risk.