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

There 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. We identified 6886 patients within a large national ad...

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Bibliographic Details
Published in:Journal of the American Heart Association 2015-11, Vol.4 (11)
Main Authors: Noseworthy, Peter A, Yao, Xiaoxi, Deshmukh, Abhishek J, Van Houten, Holly, Sangaralingham, Lindsey R, Siontis, Konstantinos C, Piccini, Sr, Jonathan P, Asirvatham, Samuel J, Friedman, Paul A, Packer, Douglas L, Gersh, Bernard J, Shah, Nilay D
Format: Article
Language:English
Subjects:
Administration, Oral
Adolescent
Adult
Aged
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - surgery
Catheter Ablation - adverse effects
Catheter Ablation - trends
Databases, Factual
Drug Administration Schedule
Embolism - diagnosis
Embolism - etiology
Embolism - prevention & control
Female
Humans
Male
Middle Aged
Multivariate Analysis
Original Research
Practice Patterns, Physicians' - trends
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Stroke - diagnosis
Stroke - etiology
Stroke - prevention & control
Time Factors
Treatment Outcome
United States
Young Adult
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Summary:There 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. We 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 CHA2DS2-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 CHA2DS2-VASc 0-1 versus ≥2, respectively; P
ISSN:2047-9980
2047-9980
DOI:10.1161/jaha.115.002597