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Pillarisetti J, Reddy M, Vodapally M, Annapureddy T, Molugu M, Atkins D, Bommana S, Pimentel R, Dendi R, Lakkireddy D. Comparison of peri-procedural anticoagulation with rivaroxaban and apixaban during radiofrequency ablation of atrial fibrillation. Indian Pacing Electrophysiol J 2020; 20:261-264. [PMID: 32810538 PMCID: PMC7691779 DOI: 10.1016/j.ipej.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Prospective studies on rivaroxaban and apixaban have shown the safety and efficacy of direct anticoagulation agents (DOAC)s used peri-procedurally during radiofrequency ablation (RFA) of atrial fibrillation (AF). Studies comparing the two agents have not been performed. Methods Consecutive patients from a prospective registry who underwent RFA of AF between April 2012 and March 2015 and were on apixaban or rivaroxaban were studied. Clinical variables and outcomes were noted. Results There were a total of 358 patients (n = 56 on apixaban and n = 302 on rivaroxaban). There were no differences in baseline characteristics between both groups. The last dose of rivaroxaban was administered the night before the procedure in 96% of patients. In patients on apixaban, 48% of patients whose procedure was in the afternoon took the medication on the morning of the procedure. TIA/CVA occurred in 2 patients (0.6%) in rivaroxaban group with none in apixaban group (p = 0.4). There was no difference in the rate of pericardial effusion between apixaban and rivaroxaban groups [1.7% vs 0.6% (p = 0.4)]. Five percent of patients in both groups had groin complications (p = 0.9). In apixaban group, all groin complications were small hematomas except one patient who had a pseudoaneurysm (1.6%). One pseudo-aneurysm, 1 fistula and 3 large hematomas were noted in patients on rivaroxaban (1.7%) with the rest being small hematomas. DOACs were restarted post procedure typically 4 h post hemostasis. Conclusions Peri-procedural uninterrupted use of apixaban and rivaroxaban during AF RFA is safe and there are no major differences between both groups.
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Affiliation(s)
| | - Madhu Reddy
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Mamatha Vodapally
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Tulasi Annapureddy
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Maruthsakhi Molugu
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Donita Atkins
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Sudharani Bommana
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Rhea Pimentel
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
| | - Raghuveer Dendi
- UT Health San Antonio, KCHRI, University of Kansas Hospital, Kansas City, KS, USA
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Kottmaier M, Bourier F, Pausch H, Reents T, Semmler V, Telishevska M, Koch-Büttner K, Lennerz C, Lengauer S, Kornmayer M, Rousseva E, Brooks S, Brkic A, Ammar-Busch S, Kaess B, Dillier R, Grebmer C, Kolb C, Hessling G, Deisenhofer I. Safety of Uninterrupted Periprocedural Edoxaban Versus Phenprocoumon for Patients Who Underwent Left Atrial Catheter Ablation Procedures. Am J Cardiol 2018; 121:445-449. [PMID: 29289359 DOI: 10.1016/j.amjcard.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 01/24/2023]
Abstract
Data about the safety of edoxaban in patients who underwent left atrial (LA) radiofrequency (RF) ablation procedures are lacking. This study sought to compare the safety of uninterrupted edoxaban with uninterrupted phenprocoumon administration during LA RF ablation for atrial fibrillation and atrial tachycardia. In total, 231 patients (mean age 64 ± 11years, male 71%) who underwent LA RF ablation under continuous oral anticoagulation (OAC) with edoxaban or phenprocoumon were included in the study. Patients on uninterrupted edoxaban (60 mg or 30 mg/day for at least 4 weeks) were matched for gender, age and type of arrhythmia with 2 patients on uninterrupted phenprocoumon (international normalized ratio 2 to 3). We identified 77 consecutive patients on edoxaban and n = 154 patients on phenprocoumon. Heparin was administered periprocedurally to achieve an activated clotting time of 280 to 300 seconds. No protamine was administered periprocedurally. The primary end point was a composite of bleeding, thromboembolic events, and death. The primary end point was met in 9 patients in the edoxaban group and in 22 patients in the phenprocoumon group (p = 0.69). No patient in either group died or had a thromboembolic complication. No major bleeding complication was observed in the edoxaban group, whereas one was found in 1 patient in the phenprocoumon group (p ≥0.99). Minor bleeding complications occurred in 9 patients (12%) in the edoxaban group and in 21 patients (14%) in the phenprocoumon group (p = 0.84). Uninterrupted OAC with edoxaban appeared to be as safe as uninterrupted OAC with phenprocoumon in patients who underwent LA RF ablation procedures.
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Escobar C, Castrejón S, de Oca RM, Ortega M, Lopez-Sendon JL, Merino JL. Common atrial flutter catheter ablation without discontinuing oral anticoagulation. Future Cardiol 2017; 13:429-432. [DOI: 10.2217/fca-2017-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine if performing catheter ablation under oral anticoagulation is associated with a higher risk of thromboembolic or bleeding complications. Methods: Patients with common atrial flutter that underwent catheter ablation of the cavo-tricuspid isthmus were consecutively included in the study. All patients were taking oral anticoagulants at least 3 weeks before the ablation. Results: A total of 102 patients (mean age 67.9 ± 10.3 years; 83.3% male) were included. Among them 80.6% patients were taking acenocoumarol, 10.7% dabigatran, 7.8% rivaroxaban and 0.9% apixaban. After the procedure, no new pericardial effusion or major complications were detected. In the study 7.8% of patients had mild hematoma in the puncture site. Conclusion: Performing common atrial flutter catheter ablation under oral anticoagulation is associated with low risk of complications.
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Affiliation(s)
- Carlos Escobar
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, IdiPaz, Madrid, Spain
- Cardiology Department, University Hospital La Paz, IdiPaz, Madrid, Spain
| | - Sergio Castrejón
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, IdiPaz, Madrid, Spain
- Hospital Ruber Juan Bravo, Madrid, Spain
| | - Rosa Montes de Oca
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, IdiPaz, Madrid, Spain
- Cardiology Department, University Hospital La Paz, IdiPaz, Madrid, Spain
| | - Marta Ortega
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, IdiPaz, Madrid, Spain
- Cardiology Department, University Hospital La Paz, IdiPaz, Madrid, Spain
| | | | - José Luis Merino
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, IdiPaz, Madrid, Spain
- Cardiology Department, University Hospital La Paz, IdiPaz, Madrid, Spain
- Hospital Ruber Juan Bravo, Madrid, Spain
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Baltogiannis G, Chierchia GB, Conte G, Sieira J, Di Giovanni G, Ciconte G, de Asmundis C, Saitoh Y, Wauters K, Irfan G, Brugada P. ‘The role of novel oral anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation’. Hellenic J Cardiol 2016; 57:331-337. [DOI: 10.1016/j.hjc.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 09/29/2016] [Indexed: 01/26/2023] Open
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Kaess BM, Ammar S, Reents T, Dillier R, Lennerz C, Semmler V, Grebmer C, Bourier F, Buiatti A, Kolb C, Deisenhofer I, Hessling G. Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon. Am J Cardiol 2015; 115:47-51. [PMID: 25456870 DOI: 10.1016/j.amjcard.2014.10.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
Apixaban is increasingly used for stroke prevention in patients with atrial fibrillation. Data about the safety of left atrial radiofrequency ablation procedures under continuous apixaban therapy are lacking. We performed a matched-cohort study of patients undergoing left atrium ablation procedures for atrial fibrillation or left atrial flutter. For each patient on apixaban, 2 patients on phenprocoumon were matched by age, gender, and type of arrhythmia. The primary safety end point was a composite of bleeding, thromboembolic events, and death. We identified 105 consecutive patients (35 women; mean age 63 years) on apixaban and matched 210 phenprocoumon patients (70 women, mean age 64 years). The primary end point was met in 11 patients of the apixaban group and 26 patients of the phenprocoumon group (10.5% vs 12.3%, p = 0.71). Major bleeding complications occurred in 1 patient of the apixaban group and 1 patient of the phenprocoumon group (1% vs 0.5%, p >0.99). Minor bleeding complications were observed in 10 patients of the apixaban group and 25 patients of the phenprocoumon group (9.5% vs 11.9%, p = 0.61). No patient in either group experienced a thromboembolic event and no patient died. In patients on apixaban, no clinical variable was predictive for bleeding complications. Left atrial ablation procedures under continuous oral anticoagulation with apixaban are feasible and as safe as under continuous oral anticoagulation with phenprocoumon.
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Krothapalli S, Bhave PD. My Patient Taking A Novel Oral Anticoagulant Needs Surgery, Device Implantation, Or Ablation. J Atr Fibrillation 2014; 7:1145. [PMID: 27957125 DOI: 10.4022/jafib.1145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a highly prevalent chronic condition and a growing number of patients are on chronic anticoagulation therapy with novel oral anticoagulant (NOAC) agents: dabigatran, rivaroxaban, and apixaban. Many of these patients are expected to require invasive procedures. There is no clear consensus regarding the peri-procedural management of patients using NOACs, as to how to minimize both bleeding risk and thromboembolism risk. This review of the current available literature is designed to help formulate peri-procedural anticoagulation strategies for patients with AF taking NOACs who are being considered for catheter ablation, device implant, or other surgery. To help frame the discussion, we offer 3 case vignettes that we will revisit to at the end of the review of the existing literature. Case 1: A 62 year-old female with hypertension, diabetes, and symptomatic paroxysmal AF who is prescribed dabigatran for thromboembolism prevention. She has failed attempts at maintaining sinus rhythm with antiarrhythmic drugs. She is now being considered for catheter ablation of AF. Case 2: A 76 year-old male with hypertension, diabetes, prior stroke, and ischemic cardiomyopathy who has persistent drug-refractory AF. He is maintained on chronic anticoagulation with dabigatran for thromboembolism prevention. He has an implantable cardioverter-defibrillator (ICD) which requires a generator change. Case 3: A 58 year-old male with hypertension and paroxysmal AF who takes rivaroxaban for thromboembolic prophylaxis and is being considered for a knee replacement surgery.
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Feasibility and Safety of Uninterrupted Rivaroxaban for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation. J Am Coll Cardiol 2014; 63:982-8. [DOI: 10.1016/j.jacc.2013.11.039] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/12/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022]
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I Garcia Md L, A Mascarenhas Md M, Ahuja Md K, Aizer Md A, Bernstein Md N, A Bernstein Md S, J Fowler Md S, S Holmes Md D, S Park Md And D, Chinitz Md L. The Safetyof Dabigatran Versus Warfarin in Patients Undergoing Atrial Fibrillation Ablation. J Atr Fibrillation 2014; 6:965. [PMID: 27957036 DOI: 10.4022/jafib.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/28/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022]
Abstract
The safety and optimal strategy of the use of dabigatran versus uninterrupted warfarin in atrial fibrillation ablation is currently unclear. We performed a retrospective analysis between July 2011-October 2012 of all patients undergoing an AF ablation who received uninterrupted warfarin therapy (199) and the routine cessation of Dabigatran therapy (126) 4 days pre-ablation. Major safety endpoints included: pericardial effusion (requiring pericardiocentesis), peripheral thromboembolism, CVA, and groin hematoma requiring blood transfusion. Minor endpoints included pericardial effusion and groin hematoma. Dabigatran was restarted the following day after ablation. The warfarin group was older, had a higher CHADS2, CHA2DS2VASc and HASBLED scores and greater prevalence of aortic plaque. The major complication rate was 2.0% in the warfarin group and 2.4% in the dabigatran group (P= 0.83). The minor complication rate was 2.5% in the warfarin group and <1% in the dabigatran group (P= 0.27). In the dabigatran group, there was one renal thromboembolic event 4 days post-ablation. All patients in the warfarin group who suffered a major complication required a blood transfusion. Cessation of dabigatran therapy 4 days pre AF ablation has a comparable safety profile to uninterrupted warfarin therapy.
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Affiliation(s)
- Luis I Garcia Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Mark A Mascarenhas Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Kartikya Ahuja Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Anthony Aizer Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Neil Bernstein Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Scott A Bernstein Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Steve J Fowler Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Douglas S Holmes Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - David S Park Md And
- The Division of Cardiology, New York University School of Medicine, New York, United States
| | - Larry Chinitz Md
- The Division of Cardiology, New York University School of Medicine, New York, United States
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