Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Biase, Luigi Di

doi:10.1007/s10840-014-9944-5

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…A single study demonstrated that uninterrupted rivaroxaban was comparable to warfarin in terms of perioperative bleeding and thromboembolic events in patients undergoing AF ablation, 29 and authors have argued for adoption of this practice. 30 Our study lends further support to the idea that NOACs may be safe and effective in this population and provides the first description of long-term stroke outcomes after ablation. We demonstrated no difference in the rates of embolic stroke, TIA, or systemic embolism between NOACs and warfarin.…”

Section: Discussionsupporting

confidence: 74%

Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation

Noseworthy

Yao

Deshmukh

et al. 2015

JAHA

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BackgroundThere is significant practice variation in oral anticoagulation (OAC) use following catheter ablation for atrial fibrillation. It is not clear whether the risk of cardioembolism increases after discontinuation of OAC following catheter ablation.Methods and ResultsWe identified 6886 patients within a large national administrative claims database who underwent catheter ablation for atrial fibrillation between January 1, 2005, and September 30, 2014. We assessed the effect of time off of OAC by CHA 2 DS 2‐VASc score (after adjusting for other comorbidities) on risk of cardioembolism, using Cox proportional hazards models. There was an increase in the use of non–vitamin K OAC after ablation from 0% in 2005 to 69.8% in 2014. OAC discontinuation was high, with only 60.5% and 31.3% of patients remaining on OAC at 3 and 12 months, respectively. The rate of discontinuation was higher in low‐risk patients (82% versus 62.5% at 12 months for CHA 2 DS 2‐VASc 0–1 versus ≥2, respectively; P<0.001). Stroke occurred in 1.4% of patients with CHA 2 DS 2‐VASc ≥2 and 0.3% of those with CHA 2 DS 2‐VASc 0 or 1 over the study follow‐up. The risk of cardioembolism in the first 3 months after ablation was increased among those with any time off OAC (hazard ratio 8.06 [95% CI 1.53–42.3], P<0.05). The risk of cardioembolism beyond 3 months was increased with OAC discontinuation among high‐risk patients (hazard ratio 2.48 [95% CI 1.11–5.52], P<0.05) but not low‐risk patients.ConclusionThe overall risk of stroke in postablation patients is low; however, OAC discontinuation after ablation is common and is associated with increased risk of cardioembolism for all patients within the first 3 months and for high‐risk patients in the long term. Continuing OAC for at least 3 months in all patients and indefinitely in high‐risk patients appears to be the safest strategy.

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Section: Discussionsupporting

confidence: 74%

Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation

Noseworthy

Yao

Deshmukh

et al. 2015

JAHA

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“…Moreover, this study confirms previous reports showing that to maintain activated clotting time (ACT) levels above 300 seconds during the AF ablation procedures, a higher amount of heparin is needed both for factor II and factor Xa inhibitor when compared to warfarin.…”

supporting

confidence: 90%

Apixaban is Dear to Me, but Dearer Still is Warfarin

Biase

2015

Pacing Clinical Electrophis

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“…This study has several study design weaknesses, such as small sample size, the absence of long standing persistent AF patients in the inclusion criteria, and the absence of dMRI to detect SCI (17,31).…”

Section: Comparison With Other Noacsmentioning

confidence: 99%

“…Non-randomized studies have evaluated the safety and feasibility of dabigatran and xarelto in the setting of AF ablation (16)(17)(18)(19)(20)(21)(22)(23). Little data is available in regards to Apixaban ,(direct factor Xa inhibitor) the latest oral anticoagulant approved for the prevention of thrombo-embolism in patients with non-valvular AF in the setting of AF ablation (15,16).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study

et al. 2015

Self Cite

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Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Cited by 9 publications

References 16 publications

Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation

Patterns of Anticoagulation Use and Cardioembolic Risk After Catheter Ablation for Atrial Fibrillation

Apixaban is Dear to Me, but Dearer Still is Warfarin

Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study

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