Key result
Warfarin users had 7.4 times higher odds of having insufficient pre-procedural hypocoagulation compared to NOAC users (12.2% vs 1.9%, p=0.001) prior to electrical cardioversion or catheter ablation.
Why the study?
Limited data exist addressing the daily use of anticoagulants for AF and AFL patients before and after electrical cardioversion or catheter ablation procedures.
Do NOACs compared to warfarin reduce insufficient pre-procedural hypocoagulation in non-valvular AF and AFL patients scheduled for cardioversion or ablation?
Observational (n=257)
No
Do NOACs compared to warfarin reduce insufficient pre-procedural hypocoagulation in non-valvular AF and AFL patients scheduled for cardioversion or ablation?
NOACs are associated with significantly lower odds of insufficient pre-procedural hypocoagulation compared to warfarin in patients undergoing cardioversion or ablation, though incorrect NOAC dosing remains common.
May warrant caution with warfarin before cardioversion or ablation; leaves open optimal periprocedural strategy pending randomized data.
Background: Limited data exists addressing the daily use of anticoagulants for atrial fibrillation (AF) and atrial flutter (AFL) patients before and after electrical cardioversion (ECV) or catheter ablation procedures. The purpose of the study was to evaluate the appropriateness of anticoagulant therapy. Methods: We evaluated the prescribed dosage of anticoagulant therapy for 257 non-valvular AF and AFL patients scheduled for ECV or catheter ablation and the appropriateness of periprocedural anticoagulation according to European Society of Cardiology (ESC) AF Guidelines. The statistical analysis was performed using IBM SPSS Statistics software (v.26.0). Results: The majority of the patients (84%) used nonvitamin K antagonist oral anticoagulants (NOACs) for pre-procedural anticoagulation. An intervention was not performed for 12.2% of warfarin users because of insufficient hypocoagulation, while anamnesis of patients’ missed doses with a possibility of inadequate hypocoagulation occurred only in 1.9% of patients on NOACs. The odds of having insufficient pre-procedural hypocoagulation were 7.4 times higher for warfarin users compared to the NOACs group (p=0.001, OR=7.4). An incorrect NOAC dose was assigned to 22 (8.6%) patients. Rivaroxaban was the most prescribed NOAC and this group of patients had the highest percentage of incorrect dosage according to the ESC guidelines. Conclusions: Mistakes of prescribing the dosage of anticoagulant therapy are common. The majority of the patients in the study were prescribed with NOACs before and after ECV or catheter ablation procedures. Warfarin users had higher odds of the intervention not being performed and not reaching sufficient hypocoagulation prior to the procedure compared to NOACs users.
No takes yet. Share an insight, caveat, or question.
Česnauskaitė et al. (2021) conducted an observational in Non-valvular atrial fibrillation or atrial flutter scheduled for electrical cardioversion or catheter ablation (n=257). NOACs (non-vitamin K antagonist oral anticoagulants) vs. Warfarin was evaluated on Insufficient pre-procedural hypocoagulation (OR 7.4, p=0.001). Warfarin users had 7.4 times higher odds of having insufficient pre-procedural hypocoagulation compared to NOAC users (12.2% vs 1.9%, p=0.001) prior to electrical cardioversion or catheter ablation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: