Abstract 12918: Comparison between Standard and Reduced Doses of Direct Oral Anticoagulants for Periprocedural Anticoagulation in Truly Low Thromboembolic Risk Patients Undergoing Catheter Ablation of Atrial Fibrillation
Introduction: Direct oral anticoagulants (DOACs) are generally administered in truly low thromboembolic risk patients undergoing atrial fibrillation (AF) ablation. All DOACs have two dose settings, but reduced doses are commonly used in patients for whom a DOAC dose reduction is not necessary according to the dose reduction criteria in the real world.
Purpose: This study aimed to evaluate the safety and efficacy of periprocedural DOACs in AF patients with a CHA2DS2-VASc score of 0 (male) or 1 (female), and compare that between standard and reduced DOAC doses.
Methods: We retrospectively enrolled 1013 consecutive patients receiving periprocedural DOACs, and 232 patients (median, 54 years) with a CHA2DS2-VASc score of 0 (190 males) or 1 (42 females) were analyzed (dabigatran, n=36; rivaroxaban, n=121; apixaban, n=59; edoxaban, n=16). Standard and reduced doses were administered in 149 and 83 patients, respectively, but essentially a dose reduction was not necessary in 95.2% of the reduced dose patients. All DOACs were discontinued on the day of the procedure and no pre-ablation heparin bridging was performed.
Results: The standard and reduced dose patients required a similar heparin dosage (median, 13630 vs. 13330 units, P=0.671), and the mean and maximum activated clotting times were 303 and 329 seconds with the standard doses, and 310 and 333 seconds with the reduced doses, respectively (P=0.012 and 0.076). No symptomatic thromboembolisms occurred. The incidence of major and minor bleeding and silent cerebral ischemic lesions on magnetic resonance imaging was 0.7%, 5.4%, and 10.0% with the standard doses and 0%, 1.2%, and 12.5% with the reduced doses, respectively (P=0.642, 0.107, and 0.558). The standard and reduced doses revealed a similar bleeding risk (2 with minor bleeding vs. 0; P=0.305) during the post-ablation oral anticoagulation (median, 106 days vs. 92 days; P=0.627).
Conclusions: Standard and reduced DOAC doses for periprocedural anticoagulation revealed a similar thromboembolic and hemorrhagic risk in CHA2DS2-VASc low-risk patients undergoing AF ablation. A reduced dose use, if not according to the dose reduction criteria, may not contribute to either a reduction in bleeding or an increase in thromboembolisms associated with AF ablation.
Author Disclosures: K. Nakamura: None. S. Naito: None. K. Minami: None. T. Sasaki: None. K. Kumagai: None. N. Funabashi: None. Y. Kobayashi: None. S. Oshima: None.
- © 2016 by American Heart Association, Inc.