Abstract 2437: Atrial Fibrillation Ablation in Patients with Therapeutic INRs: Comparison of Strategies of Anticoagulation Management in the Periprocedure Period
Introduction: Management of anticoagulation peri-pulmonary vein isolation (PVI) to cure atrial fibrillation is necessary to prevent thromboembolism while avoiding complications from anticoagulation. The best approach to management of anticoagulation around the AF ablation is not known.
Methods: We compared outcomes in consecutive patients undergoing PVI for chronic AF. Initially coumadin was stopped 3 days before ablation and a TEE was performed to rule out clot. Enoxaparin, initially 1mg/kg twice daily (Group1) and then 0.5mg/kg twice daily (Group 2) was used to bridge patients after ablation. Subsequently,Group 3 patients were kept on warfarin keeping the INR between 2–3. Heparin bolus (100 –150 units/kg) was given before trans-septal punctures. The infusion rate was adjusted to keep the activated clotting time in the range of 350 to 450 seconds. Minor bleeding was defined as hematoma not requiring intervention. Major bleeding was defined as either cardiac tamponade, hematoma requiring intervention or bleeding requiring blood transfusion.
Results (Table⇓): PVI was performed in 355 patients (Group 1±105, Group 2±100, Group 3±150. More patients had spontaneous echo contrast in groups 1 and 2. In group 1 one patient had an ischemic stroke vs. 2 patients in group 2 and no patients in group 3. In group 1 there were 13 patients with minor bleeding and 9 patients with major bleeding. In group 2 19 patients had minor bleeding and 2 patients developed pericardial effusion with no tamponade. In group 3 eight patients developed minor hematoma and no major bleeding.
Conclusion: This present study shows that continuation of warfarin through PVAI without the need for administration of enoxaparin pre and post PVI is safe and efficacious. Utilization of this strategy can prevent suboptimal anticoagulation that may increase the risk for stroke and eliminates the need for enoxaparin that is associated with more bleeding and is costly and inconvenient.