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Observational Study
. 2018 Apr 27;18(1):71.
doi: 10.1186/s12872-018-0804-6.

Periprocedural anticoagulation during left atrial ablation: interrupted and uninterrupted vitamin K-antagonists or uninterrupted novel anticoagulants

Maria Brinkmeier-Theofanopoulou  1 , Panagiotis Tzamalis  1 , Susan Wehrkamp-Richter  1 , Andrea Radzewitz  1 , Matthias Merkel  1 , Gerhard Schymik  1 , Gesine van Mark  2 , Peter Bramlage  2 , Claus Schmitt  1 , Armin Luik  3
Affiliations
Observational Study

Periprocedural anticoagulation during left atrial ablation: interrupted and uninterrupted vitamin K-antagonists or uninterrupted novel anticoagulants

Maria Brinkmeier-Theofanopoulou et al. BMC Cardiovasc Disord. .

Abstract

Background: There is a lack of data on anticoagulation requirements during ablation of atrial fibrillation (AF). This study compares different oral anticoagulation (OAC) strategies to evaluate risk of bleeding and thromboembolic complications.

Methods: We conducted a single-centre study in patients undergoing left atrial ablation of AF. Three groups were defined: 1) bridging: interrupted vitamin-K-antagonists (VKA), INR ≤2, and bridging with heparin; 2) VKA: uninterrupted VKA and INR of > 2; 3) DOAC: uninterrupted direct oral anticoagulants. Bleeding complications, thromboembolic events and peri-procedural heparin doses were assessed.

Results: In total, 780 patients were documented. At 48 h, major complications were more common in the bridging group compared to uninterrupted VKA and DOAC groups (OR: 3.42, 95% CI: 1.29-9.10 and OR: 3.01, 95% CI: 1.19-7.61), largely driven by differences in major pericardial effusion (OR: 4.86, 95% CI: 1.56-15.99 and OR: 4.466, 95% CI, 1.52-13.67) and major vascular events (OR: 2.92, 95% CI: 0.58-14.67 and OR: 9.72, 95% CI: 1.00-94.43). Uninterrupted VKAs and DOACs resulted in similar odds of major complications (overall OR: 1.14, 95% CI: 0.44-2.92), including cerebrovascular events (OR: 1.21, 95% CI: 0.27-5.45). However, whereas only TIAs were observed in DOAC and bridging groups, strokes also occurred in the VKA group. Rates of minor complications (pericardial effusion, vascular complications, gastrointestinal hemorrhage) and major/minor groin hemorrhage were similar across groups.

Conclusion: Our dataset illustrates that uninterrupted VKA and DOAC have a better risk-benefit profile than VKA bridging. Bridging was associated with a 4.5× increased risk of complications and should be avoided, if possible.

Keywords: Anticoagulation management; Atrial fibrillation; Bridging; Catheter ablation; DOAC; Vitamin-K-antagonists.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the responsible local ethics committee at the Freiburg University (Ethik Kommission des Universitätsklinikums Freiburg, Albert-Ludwigs-Universität Freiburg, Application number: 446/17). The ethics committee waived retrospective patient informed consent because it would interfere with objectives of the study and the completeness of patients, was deemed to pursue an important scientific goal and result in relevant patient outcomes. The study was performed in accordance with the Declaration of Helsinki.

Competing interests

Armin Luik (AL) has received consulting fees/honoraria from Medtronic, Inc., Boston Scientific Corp., Biosense Webster and St. Jude Medical. Peter Bramlage (PB) has received consulting fees/honoraria from Boston Scientific Corp, Edwards Lifescience, Sanofi, Daiichi Sankyo, and Aspen. Gerhard Schymik (GS) reports to have received consulting fees/honoraria from Medtronic, Edwards Lifescience and St. Jude Medical. Maria Brinkmeier Theofanopoulou (MBT), Panagiotis Tzamalis (PT), Susan Wehrkamp-Richter (SWR), Andrea Radzewitz (AR), Matthias Merkel (MM), Gesine van Mark (GvM), and Claus Schmitt (CM) reported no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Anticoagulation management groups. Patients were grouped based on different anticoagulation regimes. Bridging = interrupted vitamin-K-antagonist; DOAC = uninterrupted non-vitamin-K anticoagulants; VKA = uninterrupted vitamin-K-antagonist
See this image and copyright information in PMC

References

    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, et al. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609–1678. doi: 10.1093/europace/euw295. - DOI - PubMed
    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–38. doi: 10.1161/CIRCEP.109.859116. - DOI - PubMed
    1. Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2013;15:625–651. doi: 10.1093/europace/eut083. - DOI - PubMed
    1. Potpara TS, Larsen TB, Deharo JC, Rossvoll O, Dagres N, Todd D, Pison L, Proclemer A, Purefellner H, Blomstrom-Lundqvist C. Oral anticoagulant therapy for stroke prevention in patients with atrial fibrillation undergoing ablation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Europace. 2015;17:986–993. doi: 10.1093/europace/euv132. - DOI - PubMed
    1. Doherty JU, Gluckman TJ, Hucker WJ, Januzzi JL, Ortel TL, Saxonhouse SJ, Spinler SA. ACC expert consensus decision pathway for Periprocedural Management of Anticoagulation in patients with Nonvalvular atrial fibrillation. 2017. - PubMed

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