Influence of periprocedural anticoagulation strategies on complication rate and hospital stay in patients undergoing catheter ablation for persistent atrial fibrillation

• Published in: Clinical research in cardiology 2017, Vol.106 (1), p.38-48
• Main Authors: Gunawardene, Melanie, Willems, S., Schäffer, B., Moser, J., Akbulak, R. Ö., Jularic, M., Eickholt, C., Nührich, J., Meyer, C., Kuklik, P., Sehner, S., Czerner, V., Hoffmann, B. A.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial Fibrillation - blood; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - adverse effects; Drug Administration Schedule; Female; Humans; Length of Stay; Linear Models; Male; Medicine; Medicine & Public Health; Middle Aged; Odds Ratio; Original Paper; Perioperative Care; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - chemically induced; Retrospective Studies; Risk Assessment; Risk Factors; Thromboembolism - blood; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; Treatment Outcome; Vitamin K - antagonists & inhibitors
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-016-1021-x

Background The use of non-vitamin K antagonists (NOACs), uninterrupted (uVKA) and interrupted vitamin K antagonists (iVKA) are common periprocedural oral anticoagulation (OAC) strategies for atrial fibrillation (AF) ablation. Comparative data on complication rates resulting from OAC strategies for solely persistent AF (persAF) undergoing ablation are sparse. Thus, we sought to determine the impact of these OAC strategies on complication rates among patients with persAF undergoing catheter ablation. Methods Consecutive patients undergoing persAF ablation were included. Depending on preprocedural OAC, three groups were defined: (1) NOACs (paused 48 h preablation), (2) uVKA, and (3) iVKA with heparin bridging. A combined complication endpoint (CCE) composed of bleeding and thromboembolic events was analyzed. Results Between 2011 and 2014, 1440 persAF ablation procedures were performed in 1092 patients. NOACs were given in 441 procedures (31 %; rivaroxaban 57 %, dabigatran 33 %, and apixaban 10 %), uVKA in 488 (34 %), and iVKA in 511 (35 %). Adjusted CCE rates were 5.5 % [95 % confidence interval (CI) (3.1–7.8)] in group 1 (NOACs), 7.5 % [95 % CI (5.0–10.1)] in group 2 (uVKA), and 9.9 % [95 % CI (6.6–13.2)] in group 3. Compared to group 1, the combined complication risk was almost twice as high in group 3 [odd’s ratio (OR) 1.9, 95 % CI (1.0–3.7), p  = 0.049)]. The major complication rate was low (0.9 %). Bleeding complications, driven by minor groin complications, are more frequent than thromboembolic events ( n  = 112 vs. 1, p