Uninterrupted Anticoagulation with Non ‐Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Catheter Ablation: Lessons Learned from Randomized Trials

Catheter ablation has been established as a rhythm control strategy in select patients with atrial fibrillation (AF) who have failed or wish to avoid anti ‐arrhythmic drugs. Uninterrupted oral anticoagulation with vitamin K antagonists (VKAs) peri‐ablation is associated with a lower risk of thromboembolic and bleeding complications as compared to interrupted oral anticoagulation and bridging heparin. However, a substantial portion of patients with AF are treated with non‐vitamin K antagonist oral anticoagulants (NOACs). Herein, we perform an in‐depth review and comparison of three recent randomized trials of uninterrupted oral anticoagulation with NOACs vs. VKAs in patients undergoing AF catheter ablation. Further, we report pooled resul ts of these randomized trials. The pooled incidence of major bleeding was significantly lower with NOACs as compared to VKAs (2% vs. 4.9%, respectively; OR 0.40; 95% CI 0.16‐0.99). Similarly, cardiac tamponade was also reduced in the NOAC group (0.4% vs. 1.5%; OR 0.27; 95% CI 0.07‐0.97). Thrombo embolic complications were not significantly different between groups. Overall, these findings support the 2017 HRS/EHRA/ECAS/ APHRS/SOLAECE expert consensus statement’s class I recommendation for uninterrupted NOAC use in patients undergoing AF catheter ablation.
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: REVIEW Source Type: research

Related Links:

ConclusionsThis is the largest series to date reporting>30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
Background: It is important to understand the risk of thromboembolism and bleeding in patients with nonvalvular atrial fibrillation (NVAF) receiving direct oral anticoagulants; however, data on risk factors in Japanese patients are limited. Methods: XAPASS (Xarelto Post-Authorization Safety and Effectiveness Study in Japanese Patients with Atrial Fibrillation) is a prospective observational study examining the safety and effectiveness of rivaroxaban in Japanese real-world clinical practice. We investigated risk factors for stroke/noncentral nervous system systemic embolism (non-CNS SE)/myocardial infarction (MI) and major ...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
Age-Related Differences in the Clinical Characteristics and Treatment of Elderly Patients With Atrial Fibrillation in Japan - Insight From the ANAFIE (All Nippon AF In Elderly) Registry. Circ J. 2020 Jan 23;: Authors: Hiasa KI, Kaku H, Inoue H, Yamashita T, Akao M, Atarashi H, Koretsune Y, Okumura K, Shimizu W, Ikeda T, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Tsutsui H Abstract BACKGROUND: Atrial fibrillation (AF) is increasing as the global population ages. Elderly AF patients (≥75 years) have a worse prognosis than younger patients, and effectiv...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
This study compared the risks of ischemic stroke/systemic embolism (ISSE) and major bleeding in patients with NVAF and stage IV-V CKD treated with rivaroxaban or warfarin.MethodsPatients with NVAF and stage IV-V CKD who initiated rivaroxaban or warfarin treatment between November 2011 and June 2018 were selected from the Optum® Deidentified EHR Database. Propensity score (PS)-matching was used to balance rivaroxaban and warfarin patients on 112 measured baseline covariates. ISSE and major bleeding events over two years following treatment initiation were ascertained with validated endpoint definitions. Outcomes were an...
Source: American Heart Journal - Category: Cardiology Source Type: research
CONCLUSION:  Moderate quality evidence suggests lower INR targets reduce bleeding but increase thromboembolism in AF. The data are dominated by East-Asian studies, limiting generalizability to Western populations. Until higher quality data demonstrate otherwise, an INR range of 2 to 3 should remain standard for thromboembolic prophylaxis in AF. PMID: 31940677 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
CONCLUSION:  We showed that despite publication of the BRIDGE trial, the frequency of bridging with LMWH and patient outcomes regarding bleeding complications did not change. PMID: 31940676 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
Background Atrial fibrillation is common in the setting of acute coronary syndromes (ACS) although its impact on ACS remains controversial. Aim To describe in-hospital management of patients with atrial fibrillation and ACS evaluating the impact of atrial fibrillation on in-hospital and mid-term outcome. Methods We analysed the data of two prospective multicentre nationwide registries (IN-ACS Outcome and MANTRA) to assess clinical characteristics, management, and outcomes of patients with ACS and atrial fibrillation. Study outcomes included death from any cause and a composite end-point of death/re-infarction/strok...
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - Category: General Medicine Source Type: research
CONCLUSIONS: The follow-up of the BLITZ-AF study provide an up to date picture of the clinical course of patients with AF, who appear frequently affected by heart failure and severe comorbidities which might have led to the high mortality rate. PMID: 31952984 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
To determine risks of embolic events, bleeding, and mortality with direct oral anticoagulants (DOACs) vs warfarin in people with atrial fibrillation (AF) and dementia.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Tags: Original Study Source Type: research
More News: Atrial Fibrillation | Bleeding | Cardiology | Heart | Lessons | Vitamin K | Vitamins