Safety and Efficacy of Switching Anticoagulation to Aspirin Three Months after Successful Radiofrequency Catheter Ablation of Atrial Fibrillation.
10.3349/ymj.2014.55.5.1238
- Author:
Jae Sun UHM
1
;
Hoyoun WON
;
Boyoung JOUNG
;
Gi Byoung NAM
;
Kee Joon CHOI
;
Moon Hyoung LEE
;
You Ho KIM
;
Hui Nam PAK
Author Information
1. Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. hnpak@yuhs.ac
- Publication Type:Original Article ; Observational Study ; Research Support, Non-U.S. Gov't
- Keywords:
Anticoagulation;
aspirin;
atrial fibrillation;
catheter ablation
- MeSH:
Aged;
Anticoagulants/*therapeutic use;
Aspirin/administration & dosage/*therapeutic use;
Atrial Fibrillation/*surgery;
Catheter Ablation;
Female;
Hemorrhage/epidemiology;
Humans;
Kaplan-Meier Estimate;
Male;
Middle Aged;
Postoperative Complications/epidemiology;
Retrospective Studies;
Risk Assessment;
Thromboembolism/epidemiology;
Treatment Outcome;
Warfarin/administration & dosage/*therapeutic use
- From:Yonsei Medical Journal
2014;55(5):1238-1245
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Although current guidelines recommend continuing the same antithrombotic strategy regardless of rhythm control after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), anticoagulation has a risk of major bleeding. We evaluated the safety of switching warfarin to aspirin in patients with successful AF ablation. MATERIALS AND METHODS: Among 721 patients who underwent RFCA of AF, 608 patients (age, 57.3+/-10.9 years; 77.0% male, 75.5% paroxysmal AF) who had no evidence of AF recurrence at 3 months post-RFCA were included. We compared the thromboembolic and hemorrhagic events in patients for whom warfarin was switched to aspirin (ASA group; n=296) and patients who were kept on warfarin therapy (W group; n=312). RESULTS: There were no significant differences in CHA2DS2-VASc or HAS-BLED scores between the groups. In 30 patients in the ASA group and 37 patients in W group, AF recurred and warfarin was restarted or maintained during the 18.0+/-12.2 months of follow-up. There were no significant differences in thromboembolic (0.3% vs. 1.0%, p=0.342) and major bleeding incidences (0.7% vs. 0.6%, p=0.958) between ASA and W groups during the follow-up period. In the 259 patients with a CHA2DS2-VASc score > or =2, there were no significant differences in thromboembolism (0.8% and 2.2%, p=0.380) or major bleeding incidences (0.8% and 1.4%, p=0.640) between ASA and W groups. CONCLUSION: Switching warfarin to aspirin 3 months after successful RFCA of AF could be as safe and efficacious as long-term anticoagulation even in patients with CHA2DS2-VASc score > or =2. However, strict rhythm monitoring cannot be overemphasized.
