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See 1 citation in Circ J 2019:

Circ J. 2019 Nov 25;83(12):2418-2427. doi: 10.1253/circj.CJ-19-0602. Epub 2019 Oct 16.

Current Status and Clinical Outcomes of Oral Anticoagulant Discontinuation After Ablation for Atrial Fibrillation in Japan - Findings From the AF Frontier Ablation Registry.

Author information

1
Division of Cardiology, Nihon University Itabashi Hospital.
2
Department of Cardiology, Nihon University Hospital.
3
Department of Cardiology, The Cardiovascular Institute.
4
Cardiovascular Division, Osaka Police Hospital.
5
Divison of Cardiology, Shonan-Kamakura General Hospital.
6
Saiseikai Nakatsu Hospital.
7
Divison of Cardiology, Pulmonary Medicine and Nephrology, Hirosaki University School of Medicine.
8
Kitasato University Hospital.
9
Dokkyo Medical University Saitama Medical Center.
10
Kanazawa University Hospital.
11
Nippon Medical Hospital.
12
St. Marianna University School of Medicine Hospital.
13
Saiseikai Kumamoto Hospital.
14
Tokyo Jikei University School of Medicine Hospital.
15
National Hospital Organization Tokyo Medical Center.
16
Kyorin University Hospital.
17
Tokyo Women's Medical University Hospital.
18
Fujita University Health Hospital.
19
Tokyo Rinkai Hospital.
20
Ishikawa Prefectural Central Hospital.
21
Gunma Cardiovascular Center.
22
Juntendo University.
23
Tokyo Medical University Hospital.
24
Teikyo University.

Abstract

BACKGROUND:

The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHA2DS2-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHA2DS2-VASc scores but not with OAC status.

CONCLUSIONS:

Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.

KEYWORDS:

Ablation; Anticoagulant drugs; Atrial fibrillation; Mortality; Stroke

PMID:
31619591
DOI:
10.1253/circj.CJ-19-0602
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