Abstract 16578: Evaluation of Periprocedural Safety and Efficacy of Dabigatran, Rivaroxaban, Apixaban and Edoxaban During Catheter Ablation for Atrial Fibrillation
Backgrounds: The data on direct comparison of the novel oral anticoagulants (NOACs); dabigatran, rivaroxaban apixaban and edoxaban with each other about periprocedural complications during catheter ablation (CA) for atrial fibrillation (Af) is still unclear. The aim of this study was to evaluate the periprocedural major complications in CA for Af between four different NOACs in the real world.
Methods: A total of 1152 consecutive Af patiens (68% male; age 62.2 ± 10.7 years, paroxysmal Af 70.1%, persistent or chronic Af 29.9%) who underwent catheter ablation with NOACs at our institution were enrolled retrospectively. We divided them into four groups; dabigatran (D) group (n=516 [44.7%]), rivaroxaban (R) group (n=399 [34.6%]), apixaban (A) group (n=201 [17.4%]) and edoxaban (E) group (n= 36 [3.1%]). Outcome measures were thromboembolic events, gastric motility disorder or atrial-esophageal fistula and major bleeding complications defined as recommended by the current AHA/ACC/HRS guideline.
Results: In A group, mean CHA2DS2-Vasc score was significantly higher than both in D group (2.13 ± 1.30 vs 1.59 ± 1.27, respectively; p< 0.0001) and in R group (1.59 ± 1.35, p< 0.0001). That of E groups was 1.97 ± 1.47. Also mean HAS-BLED score was significantly higher in A group (1.34 ± 0.84) than both in D group (1.02 ± 0.89, p= 0.001) and in R group (1.06 ± 0.91, p= 0.0072). That of E groups was 1.24 ± 1.0. The incidence of major complications overall was 28 in 25 patients (2.1%). Thromboembolic event occurred in 1 patient in A group. Gastric complications occurred in 6 patients (4 in D group, 1 in R and A group). Twenty one major bleeding complication occurred in 18 patients (1 blood transfusion in D group, 13 tamponades; 8 in D group, 4 in R group and 1 in A group, 7 hematomas; 3 in D group, 3 in R group and 1 in E group). There was no significant difference in each outcome and composite of outcomes between 4 different groups.
Conclusions: Apixaban was used in patients with higher risk of thromboembolic and bleeding complications compared to dabigatran and rivaroxaban. The periprocedural major complication rates were similar between all four NOACs during Af ablation.
Author Disclosures: S. Tohoku: None. K. Hiroshima: None. M. Nagashima: None. J. Morita: None. T. Iseda: None. K. Ando: None. K. Ando: None.
- © 2016 by American Heart Association, Inc.