Key result
As-needed NOACs guided by pulse monitoring post-AF ablation show a ~0.4% annual thromboembolic event rate.
Why the study?
Patients without AF after successful ablation are often reluctant to take daily OAC despite a high stroke risk score.
Does as-needed NOAC therapy guided by diligent pulse monitoring prevent thromboembolic events safely in patients after successful atrial fibrillation ablation?
Observational (n=99)
Does as-needed NOAC therapy guided by diligent pulse monitoring prevent thromboembolic events safely in patients after successful atrial fibrillation ablation?
An as-needed NOAC strategy guided by diligent pulse monitoring appears feasible and safe for maintaining a low risk of stroke and bleeding after successful atrial fibrillation ablation.
Answers are grounded in this paper and cite their sources.
Pulse-guided as-needed NOAC post-AF ablation was associated with low event rates; hypothesis-generating and should not yet change practice.
INTRODUCTION: -VASc score is high. However, patients without AF are often reluctant to take daily OAC. We describe outcome using as needed nonvitamin K antagonist (NOACs) guided by pulse monitoring to detect AF following successful ablation. METHODS AND All patients were instructed to start NOAC if AF >1 hour or recurrent shorter episodes. Duration of NOAC use after restart was typically 2 to 4 weeks. After 30 ± 14 months (total 244 patient-years), 22 patients (22%) transitioned to daily NOAC because of noncompliance with pulse assessment or patient preference (six patients) or because of suspected or documented AF episode(s) in 16 (16%) patients. Of the remaining 77 (78%), 14 (14%) used NOACs but did not transition back to daily use, most (10 patients) with single use (seven patients) or non-AF rhythm (three patients) documented. There was only one thromboembolic event (0.4%/yr of follow-up) in patient without AF and one mild bleeding event (epistaxis). CONCLUSION: The use of as needed NOACs when AF is suspected with pulse monitoring is effective and safe to maintain low risk of stroke and bleeding after successful ablation. Transition back to daily NOAC use should be anticipated in about one quarter of patients.
No takes yet. Share an insight, caveat, or question.
Zado et al. (2019) conducted an observational in Atrial fibrillation post-ablation (n=99). As-needed nonvitamin K antagonist oral anticoagulants (NOACs) guided by pulse monitoring was evaluated on Thromboembolic events. As-needed NOACs guided by pulse monitoring after successful AF ablation resulted in only one thromboembolic event (0.4%/year) and one mild bleeding event over 30 months of follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: