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October 29, 2015Journal of Cardiovascular ElectrophysiologyOpen Access

A targeted strategy of ICM-guided intermittent NOAC administration resulted in a 94% reduction in time on NOAC compared to chronic anticoagulation, with no strokes or deaths over 466 days.

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Why the study?

Does targeted NOAC administration guided by continuous rhythm assessment with an insertable cardiac monitor reduce time on anticoagulation in patients with nonpermanent AF?

Population

59 patients on NOAC with nonpermanent AF and CHADS2 score 1 or 2, 75% male, mean age 67 ± 8 years, 76%…

Design

Cohort

Follow-up

mean 466 ± 131 days

Key result

A targeted strategy of ICM-guided intermittent NOAC administration resulted in a 94% reduction in time on NOAC compared to chronic anticoagulation, with no strokes or deaths over 466 days.

Authors

RPRod PassmanPLPeter Leong‐SitAAAdin‐Cristian Andrei

Discussion

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Overview

May reduce anticoagulation exposure in nonpermanent AF; hypothesis-generating and leaves open need for randomized safety confirmation.

Study Design

Type

Observational (n=59)

Multicenter

Yes

Structured PICO

Does targeted NOAC administration guided by continuous rhythm assessment with an insertable cardiac monitor reduce time on anticoagulation in patients with nonpermanent AF?

P
Population
59 patients on NOAC with nonpermanent AF and CHADS2 score 1 or 2, 75% male, mean age 67 ± 8 years, 76% paroxysmal AF, 69% prior AF ablation, mean CHADS2 score 1.3 ± 0.5.
I
Intervention
Targeted anticoagulation guided by continuous rhythm assessment with an insertable cardiac monitor (ICM), where NOACs were discontinued after a 60-day run-in without AF ≥ 1 hour and reinitiated for 30 days following any AF episode ≥ 1 hour.
O
Outcome
Time on NOAC, stroke, and bleeding

A targeted strategy of ICM-guided intermittent NOAC administration is feasible and significantly reduces time on anticoagulation in patients with nonpermanent AF.

Limitations

  • A large-scale trial is necessary to evaluate the safety of this approach
  • Small sample size
  • Pilot study design

Cite This Study

Passman et al. (2015) conducted an observational in Atrial Fibrillation (n=59). Targeted anticoagulation guided by continuous rhythm assessment with an insertable cardiac monitor vs. Chronic anticoagulation (historical) was evaluated on Time on NOAC, stroke, and bleeding. A targeted strategy of ICM-guided intermittent NOAC administration resulted in a 94% reduction in time on NOAC compared to chronic anticoagulation, with no strokes or deaths over 466 days.

synapsesocial.com/papers/6a194f78f9a68600c7d95d1ehttps://doi.org/10.1111/jce.12864
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