Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures.
BACKGROUND
The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients.


METHODS
A total of 630 consecutive patients who underwent 934 ablation procedures using an open irrigated tip catheter for symptomatic AF were evaluated. Outcomes were compared between patients treated with warfarin (goal INR: 2-3) versus aspirin only (325 mg/day) in CHADS2 0-1 patients after ablation.


RESULTS
Of the 690 patients, 123 (20%) were treated with aspirin and 507 (80%) with warfarin. Prevalences of the CHADS2 scores of patients on aspirin were (0: 40.7%, 1: 59.3%) and on warfarin (0: 13.6%, 1: 31.6%, > or = 2: 54.8%), P < 0.0001. Patients in the warfarin group were older, had on average a lower ejection fraction, and had higher rates persistent/permanent AF, repeat ablations, hypertension, prior stroke/TIA, and diabetes. The 1-year survival free of AF for the total study population was 71.6%. There were no strokes/TIA in the aspirin group and 4 events (4 strokes, 0 TIAs) in the warfarin group. Two patients in the warfarin group died of fatal hemorrhage (1 intracranial, 1 gastrointestinal).


CONCLUSIONS
Select low-risk patients with a low CHADS2 (0-1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone.
Bunch
T Jared
TJ
Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Murray, Utah 84107, USA. Thomas.bunch@imail.org
Crandall
Brian G
BG
Weiss
J Peter
JP
May
Heidi T
HT
Bair
Tami L
TL
Osborn
Jeffrey S
JS
Anderson
Jeffrey L
JL
Lappe
Donald L
DL
Muhlestein
J Brent
JB
Nelson
Jennifer
J
Allison
Scott
S
Foley
Thomas
T
Anderson
Lars
L
Day
John D
JD
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control*; D016019:Survival Analysis; D015996:Survival Rate; D013812:Therapeutics; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D014859:Warfarin