Key result
Minimally interrupted NOACs significantly reduced the 30-day combined complication endpoint to 2.77% compared to 4.77% with uninterrupted VKA and 8.71% with bridging heparin in patients undergoing atrial fibrillation ablation.
Why the study?
Guidelines recommend uninterrupted NOAC during AF ablation, but most centers still use minimally interrupted NOAC, warranting evaluation of its safety and effectiveness against bridging therapy and uninterrupted VKA.
Does minimally interrupted NOAC reduce combined complication endpoints compared to bridging heparin or uninterrupted VKA in patients undergoing AF ablation?
Cohort (n=4,520)
No
Does minimally interrupted NOAC reduce combined complication endpoints compared to bridging heparin or uninterrupted VKA in patients undergoing AF ablation?
In patients undergoing AF ablation, a minimally interrupted NOAC strategy is associated with fewer bleeding complications and similar thromboembolic safety compared to uninterrupted VKA or bridging heparin.
May support minimally interrupted NOACs for AF ablation; hypothesis-generating and requires randomized confirmation.
Objectives Although the latest international guidelines recommend the use of uninterrupted non-vitamin K antagonist oral anticoagulants (NOAC) during atrial fibrillation (AF) ablation, it does not reflect current clinical practice as most centers still use a minimally interrupted NOAC strategy. The purpose of this study was to evaluate the safety and effectiveness of minimally interrupted NOAC compared with bridging therapy and uninterrupted vitamin K antagonist (VKA) for non-valvular AF ablation. Methods A total of 4520 patients who underwent AF ablation between January 2010 and December 2018 were included in the analysis. According to their peri-procedural anticoagulation strategies, patients were divided into 3 groups: Bridging heparin group (n=1848); Uninterrupted VKA group (n=796) and Minimally interrupted NOAC group (Total n=1876; dabigatran: n=865; rivaroxaban, n=1011). A combined complication endpoint (CCE) as composed of any bleeding complications and thromboembolic events was analyzed. Results Rates of thromboembolisms were similar among the 3 groups (0.22% for Bridging heparin group, 0.25% for Uninterrupted VKA group and 0.11% for Minimally interrupted NOAC group, p=0.626). There was significant difference among the 3 groups for the incidence of overall bleeding events (8.50% for Bridging heparin group, 4.52% for Uninterrupted VKA group and 2.67% for Minimally interrupted NOAC group, p<0.001). A significant difference of CCE rates was shown in the Minimally interrupted NOAC group as compared with the Uninterrupted VKA group (2.77% vs. 4.77%, p=0.008) and the Bridging heparin group (2.77% vs. 8.71%, p<0.001). There was no significant difference in CCE rates among the different NOACs (dabigatran 2.9% vs. rivaroxaban 2.7%, p=0.773). Conclusions In patients undergoing AF ablation, minimally interrupted NOACs during the peri-procedural period appears safer and equally effective when compared to the bridging heparin and uninterrupted VKA therapy.
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Tang et al. (2020) conducted a cohort in Nonvalvular atrial fibrillation (n=4,520). Minimally interrupted NOAC vs. Uninterrupted VKA and bridging heparin was evaluated on Combined complication endpoint (CCE) of any bleeding and thromboembolic events (p=0.008). Minimally interrupted NOACs significantly reduced the 30-day combined complication endpoint to 2.77% compared to 4.77% with uninterrupted VKA and 8.71% with bridging heparin in patients undergoing atrial fibrillation ablation.
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