Abstract 18006: Safety of Novel Oral Anticoagulants Compared with Uninterrupted Warfarin for Catheter Ablation of Atrial Fibrillation
OBJECTIVE: The purpose of this study is to evaluate the frequency of hemorrhagic and thrombotic events as well as peri-procedural management strategies associated with the use of novel oral anticoagulants (NOACs: dabigatran, rivaroxaban, and apixaban) compared to warfarin as anticoagulation therapy for AF ablation.
METHODS: This was a retrospective cohort study from a prospective AF ablation registry maintained at a large, academic medical center. All patients undergoing AF ablation between 1/31/2012 and 12/31/13 with pre- and post-procedure anticoagulation were included.
RESULTS: The cohort included 374 patients (mean age 62 +/- 10 years, 74% male). Warfarin was used for 173 cases, dabigatran for 123 cases, rivaroxaban for 61 cases, and apixaban for 17 cases. The overall hemorrhagic/thrombotic complication rate was 14.2 % (major hemorrhage 2.7%, minor hemorrhage 11%, thrombotic stroke 0.5%). There was no significant difference in the frequency of major hemorrhage or thrombotic events associated with the use of each NOAC compared to warfarin. The frequency of minor hemorrhage with warfarin and dabigatran was 15% and 5.7% (P=0.012), respectively. There was no significant difference in minor hemorrhage when comparing rivaroxaban or apixaban to warfarin. The average heparin dose required to reach the goal ACT (≥ 350 sec) was significantly higher, compared to warfarin (5,600 +/- 2,100 units), for dabigatran (12,900 +/- 5,000 units, P<0.001), rivaroxaban (15,100 +/- 6,300 units, P<0.001), and apixaban (14,700 +/- 6,700 units, P<0.001). The average time in minutes to reach the goal ACT was also significantly longer, compared to warfarin, for dabigatran (57 vs. 28, P<0.001), rivaroxaban (63 vs. 28, P<0.001), and apixaban (72 vs. 28, P<0.001).
CONCLUSIONS: Compared to warfarin, peri-procedural anticoagulation with dabigatran resulted in fewer minor hemorrhages and total complications after AF ablation, while rates were similar with factor Xa inhibitors. Patients anticoagulated with NOACs required larger doses of heparin and took longer to reach the goal ACT compared to patients anticoagulated with warfarin. Heparin dosing nomograms for AF ablation may require upward adjustment for patients using NOACs for periprocedural anticoagulation.
Author Disclosures: J. Lindsley: None. H. Armbruster: None. M. Moranville: None. M. Habibi: None. I. Khurram: None. D.D. Spragg: None. R.D. Berger: None. H. Calkins: None. J.E. Marine: None.
- © 2014 by American Heart Association, Inc.