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J Am Coll Cardiol. 2014 Mar 18;63(10):982-8. doi: 10.1016/j.jacc.2013.11.039. Epub 2014 Jan 8.

Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry.

Author information

  • 1Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
  • 2Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
  • 3Texas Cardiac Arrhythmia Institute, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy; Department of Biomedical Engineering, University of Texas, Austin, Texas.
  • 4Massachusetts General Hospital, Boston, Massachusetts.
  • 5Texas Cardiac Arrhythmia Institute, Austin, Texas.
  • 6Mount Sinai Medical Center, New York, New York.
  • 7Arizona Heart Rhythm Center, Phoenix, Arizona.
  • 8Southlake Regional Medical Center, Toronto, Ontario, Canada.
  • 9St. Lukes Roosevelt Hospital, New York, New York.
  • 10California Pacific Medical Center, San Francisco, California.
  • 11Texas Cardiac Arrhythmia Institute, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas.

Abstract

OBJECTIVES:

The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation.

BACKGROUND:

Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown.

METHODS:

We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period.

RESULTS:

A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days.

CONCLUSIONS:

Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

periprocedural anticoagulation; radiofrequency ablation; rivaroxaban; warfarin

Comment in

PMID:
24412445
[PubMed - indexed for MEDLINE]
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