Abstract 13053: HAS-BLED Score and Atrial Fibrillation Type as Risk Factors for Bleeding Complications Associated With Catheter Ablation of Atrial Fibrillation among Patients Receiving Direct Oral Anticoagulants
Purpose: This study aimed to identify predictors of thromboembolic and hemorrhagic events associated with catheter ablation of atrial fibrillation (AF) among patients receiving periprocedural direct oral anticoagulants (DOACs).
Methods: We retrospectively studied 1034 consecutive AF patients (64±11 years; 777 males) receiving dabigatran (n=208), rivaroxaban (n=465), apixaban (n=292), or edoxaban (n=69) before AF ablation. The DOACs were continued in 61 (5.9%) patients and discontinued in 973 (94.1%) on the day of the procedure. No heparin bridging was performed before the ablation. During the procedure, heparin was given to maintain an activated clotting time (ACT) of 300-350 seconds. Major bleeding was defined as cardiac tamponade or pericardial effusions requiring drainage, intracranial and gastrointestinal hemorrhages, retroperitoneal bleeding, and bleeding requiring a blood transfusion, and vascular access site complications requiring intervention. Minor bleeding was defined as bleeding other than major bleeding.
Results: No symptomatic thromboembolisms occurred. The incidence of major and minor bleeding was 0.6% and 8.8%, respectively, and did not significantly differ among the DOACs (P=0.351 and 0.177; Figure 1). In the multivariate logistic regression analysis, the HAS-BLED score and LSP-AF were significant positive predictors of bleeding complications (odds ratios, 1.358 and 1.956; 95% CIs, 1.108-1.665 and 1.196-3.198; P=0.003 and 0.007), but the DOAC type and dose (standard/reduced), periprocedural continuation of the DOACs, total heparin dosage, and intraprocedural ACT were not significant predictors. The periprocedural bleeding risk increased with higher HAS-BLED scores (Figure 2).
Conclusions: Periprocedural DOAC treatment with adequate intraprocedural anticoagulation was effective in preventing symptomatic thromboembolisms. A higher HAS-BLED score and LSP-AF can be high risk factors for bleeding complications.
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.