Early Experience of Novel Oral Anticoagulants in Catheter Ablation for Atrial Fibrillation: Efficacy and Safety Comparison to Warfarin.
10.3349/ymj.2016.57.2.342
- Author:
Dong Geum SHIN
1
;
Tae Hoon KIM
;
Jae Sun UHM
;
Joung Youn KIM
;
Boyoung JOUNG
;
Moon Hyoung LEE
;
Hui Nam PAK
Author Information
1. Department of Cardiology, Yonsei University Health System, Seoul, Korea. hnpak@yuhs.ac
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Atrial fibrillation;
catheter ablation;
novel oral anticoagulant;
warfarin
- MeSH:
Aged;
Anticoagulants/*therapeutic use;
Atrial Fibrillation/complications/*drug therapy/*surgery;
Catheter Ablation/*methods;
Female;
Follow-Up Studies;
Hemorrhage/epidemiology;
Heparin;
Humans;
Incidence;
Male;
Middle Aged;
Postoperative Complications/epidemiology;
Stroke/epidemiology;
Thromboembolism/epidemiology;
Treatment Outcome;
Warfarin/administration & dosage/*therapeutic use
- From:Yonsei Medical Journal
2016;57(2):342-349
- CountryRepublic of Korea
- Language:English
-
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.
