Immediate post-procedure bridging with unfractioned heparin versus low molecular weight heparin in patients undergoing radiofrequency ablation for atrial fibrillation with an interrupted oral anticoagulation strategy

• Published in: Journal of interventional cardiac electrophysiology 2016-03, Vol.45 (2), p.149-158
• Main Authors: Loughlin, Gerard, Romaniega, Tomás Datino, Garcia-Fernandez, Javier, Calvo, David, Salgado, Ricardo, Alonso, Andres, Li, Xin, Arenal, Angel, González-Torrecilla, Esteban, Atienza, Felipe, Fernández-Avilés, Francisco
• Format: Article
• Language: English
• Subjects: Anticoagulants - administration & dosage; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - statistics & numerical data; Causality; Comorbidity; Drug Administration Schedule; Drug Substitution; Female; Hemorrhage - epidemiology; Hemorrhage - prevention & control; Heparin - administration & dosage; Heparin, Low-Molecular-Weight - administration & dosage; Humans; Incidence; Male; Medicine; Medicine & Public Health; Middle Aged; Multimedia Report; Organization and Administration; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Premedication; Prevalence; Retrospective Studies; Risk Factors; Spain - epidemiology; Thromboembolism - epidemiology; Thromboembolism - prevention & control; Treatment Outcome
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-015-0098-x

Purpose Many centers perform catheter ablation for atrial fibrillation (AF) with periprocedural interruption of oral vitamin K antagonists. In this scenario, the optimal post-procedural anticoagulation strategy is still under debate. We sought to compare the incidence of major complications associated with post-procedural use of low molecular weight heparin (LMWH) versus unfractioned heparin (UFH) as a bridge to reinitiation of oral anticoagulation after an AF ablation procedure. Methods We retrospectively reviewed medical history data of all patients undergoing catheter ablation for AF at three Spanish referral centers between January 2009 and January 2014. A total of 702 patients were included in the analysis. We compared the incidence of major complications (a combination of major bleeding and thromboembolic events) between patients receiving UFH (291) and those receiving LMWH (411) after the procedure. Results The overall incidence of major complications was 4.1 %, including five thromboembolic events (0.7 %) and 24 major bleeding events (3.4 %), with no significant differences in patients treated with LMWH vs. UFH (2.9 vs. 4.1 %; P  = NS). The presence of peripheral vascular disease emerged as the only independent predictor of major complications (adjusted odds ratio (OR) 9.1; confidence interval (CI) 95 % 1.7–49.3; P