Abstract 15832: Switching Between New Oral Anticoagulants and Warfarin in Patients Undergoing Catheter Ablation of Atrial Fibrillation: Safety and Outcomes
Introduction. Periprocedural maintenance of therapeutic anticoagulation with warfarin is a safe and effective anticoagulation protocol in patients undergoing catheter ablation of atrial fibrillation (AF). Recently, an increased risk of bleeding and thromboembolism with dabigatran has been reported in the setting of AF ablation, and no data are available on the safety of rivaroxaban. Therefore, switching between these new oral anticoagulants and warfarin before the ablation procedure has been increasingly adopted in many Centers. We report the safety and outcomes of periprocedural switching between new oral anticoagulants and warfarin in a large series of patients undergoing catheter ablation of AF.
Methods. 617 consecutive patients under chronic treatment with either dabigatran (534/617 [87%]) or rivaroxaban (83/617 [13%]) were referred to our Institutions for catheter ablation of AF. Patients were switched to warfarin at least 2 months before the scheduled ablation procedure, with bridging until achievement of a therapeutic INR. After ablation, warfarin was continued for 1 to 3 months and then patients were switched back to dabigatran/rivaroxaban after 1 day of bridging. Data on pre-procedural, peri-procedural, and post-procedural complications were prospectively collected.
Results. The majority (64%) of patients had non-paroxysmal AF, with 37% having a CHADS2 score ≥2. No thromboembolic or bleeding event was observed during both the pre-procedural and post-procedural period, when switching between dabigatran/rivaroxaban and warfarin was performed. Peri-procedural complications occurred in 27/617 (4.4%, 95% confidence interval [CI] 3.1% to 6.3%), and consisted of 25 minor bleeding events (4.1%) and 2 pericardial effusions not requiring surgery (0.3%). No peri-procedural thromboembolic complication occurred.
Conclusions. In patients undergoing catheter ablation of AF, switching between new anticoagulants (dabigatran and rivaroxaban) and warfarin is safe and is not associated with increased risk of thromboembolism or bleeding.
- © 2012 by American Heart Association, Inc.