What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=376). Intervention: Uninterrupted direct oral anticoagulants (DOACs) vs. Uninterrupted vitamin K antagonist (VKA). Primary outcome: Total periprocedural complications (propensity score-matched) (p=0.65).

April 12, 2018Open Access

Periprocedural Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation Without Discontinuation of a Vitamin K Antagonist and Direct Oral Anticoagulants

Key Result

Uninterrupted direct oral anticoagulants during catheter ablation for atrial fibrillation resulted in similar rates of periprocedural complications compared to uninterrupted vitamin K antagonists (3.2% vs 4.8%, p=0.65).

Study Design

Type

Observational (n=376)

Multicenter

Structured PICO

Does uninterrupted DOAC therapy reduce periprocedural complications compared to uninterrupted VKA therapy in patients undergoing catheter ablation for atrial fibrillation?

Population

376 patients with atrial fibrillation undergoing catheter ablation on uninterrupted anticoagulation, comparing direct oral anticoagulants to vitamin K antagonists.

Exposure

Uninterrupted direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, apixaban, or edoxaban) continued throughout the periprocedural period.

Comparator

Uninterrupted vitamin K antagonist (VKA) therapy (target INR 1.5-3) continued throughout the periprocedural period.

Outcome

Total periprocedural complications (composite of stroke/TIA, bleeding, and cardiac tamponade) throughout the periprocedural period and up to the time of the first outpatient visit.safety

Uninterrupted DOAC therapy is a safe alternative to uninterrupted VKA therapy for patients undergoing catheter ablation of atrial fibrillation, with no significant difference in periprocedural ischemic or hemorrhagic complications.

Main Result

Absolute Event Rate: 3.2% vs 4.8%

p-value: p=0.65

Limitations

Retrospective, observational, nonrandomized, single-center study design limits generalizability.
Propensity score matching significantly decreased the sample size available for comparison.

Abstract

BACKGROUND: Periprocedural anticoagulation is important in catheter ablation (CA) of atrial fibrillation (AF) and there is increasing evidence that uninterrupted vitamin K antagonist (VKA) therapy is superior to interrupted anticoagulation strategies. Since the emergence of direct oral anticoagulants (DOACs), numerous studies have shown promising results for their use in uninterrupted strategies. However, further studies are needed to further deﬁne the efﬁcacy and safety of performing AF ablation with uninterrupted factor XA inhibitors or direct thrombin inhibitors. METHODS AND RESULTS: -VASc and HAS-BLED scores. Therefore, we also analyzed the results using the propensity score-matching method. We found no significant difference in periprocedural complications between uninterrupted VKA or DOACs therapy (P=0.65). CONCLUSIONS: CA of AF without discontinuation of DOACs is not inferior to CA without discontinuation of a VKA, with regard to ischemic or hemorrhagic complications.

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