Why the study?
Specific subgroups of patients undergoing catheter ablation for AF face increased risks of bleeding and thromboembolism, but periprocedural edoxaban concentrations and coagulation biomarkers across these subgroups were uncharacterized.
Does uninterrupted edoxaban with a delayed dose maintain stable coagulation biomarkers across different thromboembolic risk profiles and AF types in patients undergoing catheter ablation?
Does uninterrupted edoxaban with a delayed dose maintain stable coagulation biomarkers across different thromboembolic risk profiles and AF types in patients undergoing catheter ablation?
Uninterrupted edoxaban with a delayed dose on the day of catheter ablation maintains stable coagulation biomarkers regardless of baseline thromboembolic risk or AF type.
Should not yet change practice by CHADS2 or AF type; leaves open whether event rates remain low in higher-risk patients.
Background Catheter ablation (CA) for atrial fibrillation (AF) can be associated with a risk of thromboembolism and bleeding. We recently demonstrated that uninterrupted edoxaban with one dose delayed on the CA procedural day is associated with a low risk of periprocedural complications. Previous reports have indicated that some specific subgroups of patients undergoing CA have an increased risk of bleeding and thromboembolic complications. This subanalysis of the KYU‐RABLE study assessed the changes in plasma concentrations of edoxaban and coagulation biomarkers during the periprocedural period of CA in subgroups stratified by the risk of thromboembolism assessed by CHADS 2 score (<2 or ≥2) and AF type (paroxysmal AF [PAF] or non‐PAF). Methods We evaluated changes in plasma concentrations of edoxaban and coagulation biomarkers (D‐dimer and prothrombin fragment F1+2), by subgroup, during the periprocedural period of CA. Measurements were made prior to CA (procedure day). Results This subanalysis evaluated data from 343 patients with CHADS 2 score <2 and 134 patients with CHADS 2 score ≥2, and from 280 patients with PAF and 197 patients with non‐PAF. Plasma edoxaban concentration decreased with time on the day of CA, while plasma concentrations of coagulation biomarkers remained unchanged. No significant differences were observed according to CHADS 2 score or type of AF. Conclusions The changes in plasma concentrations of edoxaban and coagulation biomarkers in each subgroup were similar to those of the whole analysis, regardless of the thromboembolic risk (CHADS 2 <2 or ≥2) or AF type (PAF or non‐PAF).
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Shinohara et al. (2020) studied this question.
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