Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients

Breugel, Henrica N.A.M. van; Gelsomino, Sandro; Lozekoot, Pieter; Accord, Ryan E.; Lucà, Fabiana; Parise, Orlando; Crijns, Harry J.G.M.

doi:10.1093/icvts/ivt522

Cited by 3 publications

(5 citation statements)

References 25 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CHA 2 DS 2 -VASc score as a significant predictor of anticoagulant prescribing before catheter ablation in our population was observed. The higher CHA 2 DS 2 -VASc score was associated with a higher anticoagulation prescription preablation, which was inconsistent with the discovery by Bista et al 17,21 Furthermore, HAS-BLED score, age, hypertension, and diabetes mellitus were also related to the use of anticoagulant before catheter ablation. Although those factors were observed as negative predictors for anticoagulant prescribing after catheter ablation, we found that the higher CHA 2 DS 2 -VASc score was associated with less frequent prescription of NOACs, which may illustrate that practitioner reluctant to use a newer therapy for higher embolism risk patients.…”

Section: Discussionmentioning

confidence: 63%

“…8 Accordingly, those studies before 2017 were assessed by the consensus of 2012, which indicated irrational utilization of anticoagulation after ablation. 21,22…”

Section: Discussionmentioning

confidence: 99%

“…8 Accordingly, those studies before 2017 were assessed by the consensus of 2012, which indicated irrational utilization of anticoagulation after ablation. 21,22 Ultimately, 185 (38.95%) patients turned to NOACs therapy, of which 42 (22.7%) transitioned from warfarin to NOAC therapy. Nevertheless, only 3 (0.63%) patients changed from NOACs to warfarin therapy.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

Chen

Wang

Zhang

et al. 2019

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Both vitamin K antagonists (VKAs) and novel oral anticoagulants (NOACs) are effective for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients. This study evaluated the utilization of VKA and NOACs in NVAF patients before and after catheter ablation in China. Prescription data were retrospectively collected between January 1, 2016, and December 31, 2016, including indication of use, dose, renal function, and risk assessment (CHA 2 DS 2 -VASc score and HAS-BLED score) in Zhongshan Hospital of Fudan University. Trends and factors associated with anticoagulants use before and after ablation were evaluated. A total of 475 patients with NVAF who received ablation were included in the analysis. Of all, 53.26% of them received antithrombotic therapy preablation. Warfarin was prescribed in 35.26%, with NOACs in 11.37%. Four hundred seventy-three patients received antithrombotic therapy (99.58%) postablation, 236 patients with NOACs (49.68%). CHA 2 DS 2 -VASc score, HAS-BLED score, hypertension, diabetes mellitus, and alcohol were independently associated with anticoagulant utilization before catheter ablation. The higher CHA 2 DS 2 -VASc score was associated with less frequent prescription of NOACs postablation. The preablation anticoagulation use was still inadequate in China, and CHA 2 DS 2 -VASc score was a significant factor influencing the preablation anticoagulant utilization. The utilization rate of NOACs increased significantly postablation, especially for dabigatran, which implied that more physicians prefer to prescribe NOACs for NVAF patients after ablation in our country and may be attributed to the aspects such as ease of NOAC use but also possibly the greater safety and efficacy. Furthermore, the physicians may reluctant to use NOACs for high stroke risk atrial fibrillation patients after catheter ablation.

show abstract

Section: Discussionmentioning

confidence: 63%

“…8 Accordingly, those studies before 2017 were assessed by the consensus of 2012, which indicated irrational utilization of anticoagulation after ablation. 21,22…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

Chen

Wang

Zhang

et al. 2019

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Catheter ablation (CA) procedures performed in the left atrium (LA) or left ventriculum (LV) present a rather unique situation, encompassing risks of both significant bleeding and thrombotic events. According to the latest international guidelines, CA of AF should proceed without interruption of DOACs [ 7 , 60 , 94 , 95 ], and it is mandatory to utilize unfractionated heparin (UFH) before or immediately after the trans-septal puncture to reach and maintain a target activated clotting time (ACT) of at least ≥300 s [ 94 ]. As assessed in several studies [ 96 ], in patients with uninterrupted DOAC, often a greater amount of UFH is needed to reach the target of ACT ≥ 300 s, and the administration of a higher amount of heparin was associated with an increased rate of procedural major bleedings.…”

Section: Interventions With High Bleeding Risk and Increased Thromboe...mentioning

confidence: 99%

Exploring the Perioperative Use of DOACs, off the Beaten Track

Lucà,

Oliva,

Giubilato

et al. 2024

JCM

View full text Add to dashboard Cite

A notable increase in direct oral anticoagulant (DOAC) use has been observed in the last decade. This trend has surpassed the prescription of vitamin K antagonists (VKAs) due to the absence of the need for regular laboratory monitoring and the more favorable characteristics in terms of efficacy and safety. However, it is very common that patients on DOACs need an interventional or surgical procedure, requiring a careful evaluation and a challenging approach. Therefore, perioperative anticoagulation management of patients on DOACs represents a growing concern for clinicians. Indeed, while several surgical interventions require temporary discontinuation of DOACs, other procedures that involve a lower risk of bleeding can be conducted, maintaining a minimal or uninterrupted DOAC strategy. Therefore, a comprehensive evaluation of patient characteristics, including age, susceptibility to stroke, previous bleeding complications, concurrent medications, renal and hepatic function, and other factors, in addition to surgical considerations, is mandatory to establish the optimal discontinuation and resumption timing of DOACs. A multidisciplinary approach is required for managing perioperative anticoagulation in order to establish how to face these circumstances. This narrative review aims to provide physicians with a practical guide for DOAC perioperative management, addressing the most controversial issues.

show abstract

“…This is also true for oral anticoagulants (OACs), which often require lifelong treatment. Many studies have explored the short- and long-term adherence rates of OAC among patients with AF or VTE in real-world settings [ 163 ]. The adherence rate in OAC users ranges widely depending on the setting and patient characteristics and decreases over time [ 164 ].…”

Section: Adherence To Oral Anticoagulant Intakementioning

confidence: 99%

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Lucà,

Oliva,

Abrignani

et al. 2023

JCM

View full text Add to dashboard Cite

It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug–drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.

show abstract

Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients

Cited by 3 publications

References 25 publications

Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

Exploring the Perioperative Use of DOACs, off the Beaten Track

Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Contact Info

Product

Resources

About