October 27, 2016Journal of ArrhythmiaOpen Access

Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)

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Why the study?

Does periprocedural use of direct oral anticoagulants compared to warfarin change the incidence of serious complications in patients undergoing catheter ablation for atrial fibrillation?

Structured PICO

Does periprocedural use of direct oral anticoagulants compared to warfarin change the incidence of serious complications in patients undergoing catheter ablation for atrial fibrillation?

Population

4,698 patients (mean age 63.2±10.6 years, 73.9% male) who underwent atrial fibrillation ablation and were administered warfarin or a direct oral anticoagulant at least up to the day before the procedure, from 204 institutions in Japan.

Intervention

Periprocedural direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban) administered at least up to the day before atrial fibrillation ablation.

Comparator

Periprocedural warfarin administered at least up to the day before atrial fibrillation ablation.

Outcome

Incidence of serious complications, including pericardial effusion requiring pericardiocentesis or surgery, major bleeding (hemothorax, retroperitoneal hematoma, massive bleeding at puncture site), and ischemic stroke.safety

Periprocedural use of direct oral anticoagulants during atrial fibrillation ablation is as safe as uninterrupted warfarin, with no significant difference in serious bleeding or thromboembolic complications.

Limitations

Observational study design with inherent biases
Diagnosis of complications was entirely entrusted to individual physicians
Details of the dosage regimen of OACs and heparin usage in individual patients were not included

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Periprocedural DOAC use shows comparable complication rates to warfarin in AF ablation; leaves open need for randomized confirmation before practice change.

Cite This Study

Murakawa et al. (2016) studied this question.

synapsesocial.com/papers/6a8064432cf87dafd7c88cf6 https://doi.org/10.1016/j.joa.2016.10.002

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Implication

Periprocedural DOAC use shows comparable complication rates to warfarin in AF ablation; leaves open need for randomized confirmation before practice change.

Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF)

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider