The Optimal Range of International Normalized Ratio for Radiofrequency Catheter Ablation of Atrial Fibrillation During Therapeutic Anticoagulation With Warfarin

Abstract

Background-Uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation is associated with a lower risk of periprocedural complications than when warfarin is temporarily discontinued. However, the optimal international normalized ratio (INR) levels during RFA have not been defined.

Safety of Continuous Periprocedural Rivaroxaban for Patients Undergoing Left Atrial Catheter Ablation Procedures

“…2 A proper periprocedural anticoagulation management is mandatory to minimize the thromboembolic and bleeding risk. 3,4 Clinical Perspective on p 582…”

“…Uninterrupted periprocedural anticoagulation with warfarin has been shown to be safe and effective when using an international normalized ratio between 2 and 2.5. 3,4 As alternative to vitamin K antagonists (VKA), new oral anticoagulants, such as rivaroxaban, dabigatran, and apixaban, were recently approved for the prevention of stroke or systemic embolism in patients with nonvalvular AF. 1,5 To date, there is no standardized approach in the management of periprocedural anticoagulation in patients on new oral anticoagulants undergoing left atrial (LA) procedures.…”

Konsensus-Statement – Schlaganfallprophylaxe bei nicht-valvulärem Vorhofflimmern unter besonderer Berücksichtigung der direkten oralen Antikoagulanzien

“…Unter einer therapeutischen (INR 2,0-2,5), für die Ablation nicht unterbrochenen Therapie mit VKA konnte diese Rate relevant gesenkt werden. Daher wird diese Strategie, mit periinterventioneller Gabe von unfraktioniertem Heparin (Activated Clotting Time -ACT -über 300), von den meisten Zentren umgesetzt [40]. DOAK Die Problematik der Therapie mit DOAK im Zuge der Pulmonalvenenisolation ist die fehlende Erfahrung im Umgang mit Blutungskomplikationen (Perikardtamponade).…”

Metabolic benefits of rivaroxaban in non-valvular atrial fibrillation patients after radiofrequency catheter ablation

“…Anticoagulation therapy is the most effective method to prevent stroke and systematic thromboembolism events (Vazquez et al, 2010). Up to now, the optimal anticoagulation protocols after radiofrequency catheter ablation (RFCA) for nonvalvular atrial fibrillation (NVAF) patients are still being investigated (Santangeli et al, 2012;Kim et al, 2013). Warfarin has been shown to be safe and effective when maintaining a therapeutic international normalized ratio (INR) between 2 and 3 (Ansell et al, 2008).…”