Key result
DOACs match VKAs for stroke prevention with lower bleeding risk during AF ablation.
Why the study?
Well evidenced anticoagulation protocols during pulmonary vein isolation for atrial fibrillation are important due to high bleeding and thromboembolic risk and new evidence has emerged since 2018.
What are the optimal anticoagulation strategies during the periprocedural period of atrial fibrillation ablation?
What are the optimal anticoagulation strategies during the periprocedural period of atrial fibrillation ablation?
This review highlights that DOACs are generally safer and equally effective as VKAs for periprocedural anticoagulation in AF ablation, though the choice between interrupted and uninterrupted NOAC strategies remains debated.
Different post-2018 anticoagulation strategies during PVI show variability; leaves open optimal regimen balancing bleeding and thromboembolic risks.
Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice and is often treated with pulmonary vein isolation (PVI).This procedure has both high bleeding and thromboembolic risk; therefore well evidenced anticoagulation protocols are important.The anticoagulation strategy in patients undergoing PVI is described in the Expert Consensus.We analyzed studies released after 2018 pertaining to anticoagulation during PVI.Different anticoagulation approaches for AF ablation were studied.New evidence on edoxaban and apixaban for PVI emerged.Direct oral anticoagulants (DOACs) seemed to be safer in terms of bleeding risk and equally effective in stroke prevention compared to vitamin K antagonists (VKAs) according to one metanalysis.Uninterrupted and interrupted anticoagulation strategies with novel oral anticoagulants (NOACs) were studied and brought conflicting results.The "dabigatran bridge" strategy for PVI was tested.New knowledge on the occurrence and clinical significance of silent brain ischemic lesions after PVI is described.An alternative heparin dosing strategy during PVI in patients on NOACs was proposed.
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Maciejewski et al. (2020) conducted a review in Atrial fibrillation undergoing pulmonary vein isolation. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Bleeding risk and stroke prevention. Direct oral anticoagulants appeared safer in terms of bleeding risk and equally effective in stroke prevention compared to vitamin K antagonists during atrial fibrillation ablation.
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