Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study

Kuwahara, Taishi; Abe, Mitsunori; Yamaki, Masaru; Fujieda, Hiroyuki; Abe, Yumiko; Hashimoto, Katsushi; Ishiba, Misako; Sakai, Hirotsuka; Hishikari, Keiichi; Takigawa, Masateru; Okubo, Kenji; Takagi, Katsumasa; Tanaka, Yasuaki; Nakajima, Jun; Takahashi, Atsushi

doi:10.1111/jce.12928

Cited by 80 publications

(61 citation statements)

References 34 publications

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“…Another randomized study compared uninterrupted apixaban versus continuous warfarin in 200 subjects with drug-refractory AF undergoing ablation and found no difference in thromboembolic or bleeding outcomes. 153 There are several ongoing larger randomized clinical trials of interrupted versus uninterrupted NOAC therapy and continuous warfarin versus continuous NOAC therapy.…”

Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

218

147

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Non–vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

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Section: Periprocedural Management Of Patients Who Take Noacsmentioning

confidence: 99%

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Raval¹,

Cigarroa²,

Chung³

et al. 2017

Circulation

218

147

View full text Add to dashboard Cite

show abstract

“…Another randomized controlled trial where patients were randomized to uninterrupted warfarin versus uninterrupted apixaban with MRI performed in all patients before and after ablation showed similar rates of SCLs/SCEs and other complications in both groups. 67 Moreover, in the multivariate analysis by Nakamura et al 63 there was no statistically significantly increased risk of SCLs/SCEs when using apixaban (p ¼ 0.090). In summary, there is clear benefit from uninterrupted anticoagulation with warfarin in reducing the risk of thromboembolism.…”

Section: Pre-procedural Anticoagulationmentioning

confidence: 94%

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

Ponamgi¹,

Yasin²,

Padmanabhan³

et al. 2016

JICRM

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ABSTRACT. Despite continued innovations in catheter design and technique, catheter ablation for atrial fibrillation (AF) is still fraught with a few serious complications-most feared of which is stroke. Although a ''classic'' clinically disabling stroke is less common (about 1%) after AF ablation, many recent studies have identified an increased incidence of asymptomatic ischemic cerebral lesions known as ''silent clinical lesions'' (SCLs) associated with the procedure. As once thought, these new SCLs seen on post-ablation magnetic resonance imaging of the brain were not actually clinically ''silent'' and were shown to have significant clinical and neuropsychiatric effects on these patients in the long term. These SCLs are thought to represent the ''embolic fingerprints'' of the ablation procedure, suggesting involvement and the need for innovation as well as improved safety at multiple levels before, during, and after the procedure. This may require a multimodality approach involving several measures such as having better peri-procedural anticoagulation strategies, using real-time monitoring for markers of neurologic injury, giving meticulous attention to sheath management, using novel energy sources that are less thrombogenic, and finally establishing imaging protocols for timely detection of these lesions post ablation. The current literature is reviewed here to explore such opportunities to improve neurological outcomes of catheter ablation for AF.

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“…Eine Reduktion von Thrombembolien ohne eine Zunahme von Blutungen konnte schon in monozentrischen, kleinen Studien und einem prospektiven Register gezeigt werden [21][22][23]. Auch eine Metaanalyse, in der 4 Studien und insgesamt fast 1700 Patienten zusammengefasst wurden, konnte keine signifikanten Unterschiede zwischen Apixaban und VKA finden, wenn die beiden Medikamente jeweils ohne Unterbrechung im Rahmen einer PVI appliziert wurden [24].…”

Section: Apixabanunclassified

S1 Leitlinie – Österreichischer Konsensus zur Antikoagulation im Rahmen der Vorhofflimmerablation

Martinek

Gwechenberger²,

Scherr

et al. 2018

Wien Klin Wochenschr

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Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study

Abstract: Apixaban has similar safety and effectiveness to warfarin for the prevention of cerebral thromboembolism during the periprocedural period of AF ablation.

Cited by 80 publications

References 34 publications

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

S1 Leitlinie – Österreichischer Konsensus zur Antikoagulation im Rahmen der Vorhofflimmerablation

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