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Periprocedural anticoagulation during left atrial ablation: interrupted and uninterrupted vitamin K-antagonists or uninterrupted novel anticoagulants.
- Source :
- BMC Cardiovascular Disorders; 4/27/2018, Vol. 18 Issue 1, p1-10, 10p, 1 Diagram, 6 Charts
- Publication Year :
- 2018
-
Abstract
- <bold>Background: </bold>There is a lack of data on anticoagulation requirements during ablation of atrial fibrillation (AF). This study compares different oral anticoagulation (OAC) strategies to evaluate risk of bleeding and thromboembolic complications.<bold>Methods: </bold>We conducted a single-centre study in patients undergoing left atrial ablation of AF. Three groups were defined: 1) bridging: interrupted vitamin-K-antagonists (VKA), INR ≤2, and bridging with heparin; 2) VKA: uninterrupted VKA and INR of > 2; 3) DOAC: uninterrupted direct oral anticoagulants. Bleeding complications, thromboembolic events and peri-procedural heparin doses were assessed.<bold>Results: </bold>In total, 780 patients were documented. At 48 h, major complications were more common in the bridging group compared to uninterrupted VKA and DOAC groups (OR: 3.42, 95% CI: 1.29-9.10 and OR: 3.01, 95% CI: 1.19-7.61), largely driven by differences in major pericardial effusion (OR: 4.86, 95% CI: 1.56-15.99 and OR: 4.466, 95% CI, 1.52-13.67) and major vascular events (OR: 2.92, 95% CI: 0.58-14.67 and OR: 9.72, 95% CI: 1.00-94.43). Uninterrupted VKAs and DOACs resulted in similar odds of major complications (overall OR: 1.14, 95% CI: 0.44-2.92), including cerebrovascular events (OR: 1.21, 95% CI: 0.27-5.45). However, whereas only TIAs were observed in DOAC and bridging groups, strokes also occurred in the VKA group. Rates of minor complications (pericardial effusion, vascular complications, gastrointestinal hemorrhage) and major/minor groin hemorrhage were similar across groups.<bold>Conclusion: </bold>Our dataset illustrates that uninterrupted VKA and DOAC have a better risk-benefit profile than VKA bridging. Bridging was associated with a 4.5× increased risk of complications and should be avoided, if possible. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTICOAGULANTS
VITAMIN K
ATRIAL fibrillation
HEMORRHAGE
THROMBOEMBOLISM
ATRIAL fibrillation diagnosis
THROMBOEMBOLISM prevention
STROKE prevention
CATHETER ablation
COMPARATIVE studies
DRUG administration
RESEARCH methodology
MEDICAL cooperation
ORAL drug administration
RESEARCH
STROKE
TIME
EVALUATION research
TREATMENT effectiveness
RETROSPECTIVE studies
CHEMICAL inhibitors
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 14712261
- Volume :
- 18
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Cardiovascular Disorders
- Publication Type :
- Academic Journal
- Accession number :
- 129330559
- Full Text :
- https://doi.org/10.1186/s12872-018-0804-6