Uninterrupted warfarin for periprocedural anticoagulation in catheter ablation of typical atrial flutter: a safe and cost-effective strategy.
BACKGROUND
Many patients undergoing catheter ablation of atrial flutter (AFL) require periprocedural anticoagulation. We compared a strategy of conversion to low molecular weight heparin (LMWH) periprocedure to uninterrupted warfarinization in a nonrandomized, case-controlled study.


METHODS
One hundred and one consecutive patients requiring periprocedural anticoagulation for catheter ablation of typical AFL were studied. The first 51 patients underwent conversion to LMWH (enoxaparin 1 mg/kg bd) with a warfarin pause (LMWH group), the subsequent 50 continued with uninterrupted oral anticoagulation (Warfarin group). Primary endpoint was a composite of major and minor bleeding complications and groin symptoms.


RESULTS
Fewer patients in the Warfarin group reached the primary endpoint (36.0% vs 56.8%, P = 0.013). Four patients in the LMWH group but no patient in the Warfarin group required hospital admission for bleeding-related complications. Cost analysis showed mean cost per patient of anticoagulation with LMWH to be pounds sterling 100.9 (95% CI 94.46-107.30) compared to pounds sterling 10.23 (4.49-15.97) in the Warfarin group (P < 0.0001). Transesophageal echocardiography (TEE) was performed prior to ablation in 11 patients in the Warfarin group and in 3 patients in the LMWH (P = 0.019). When TEE costs were included, costs were pounds sterling 125.00 ($188.25) (96.80-153.60) for the LMWH strategy and pounds sterling 108.5 ($163.40) (54.92-162.1) for the Warfarin group (P < 0.0001).


CONCLUSIONS
Catheter ablation of typical AFL without interruption of warfarin appears safer and more cost-effective than periprocedural conversion to LMWH. It could be used as a routine anticoagulation strategy for the ablation of right-sided arrhythmias.
Department of Cardiology, St. Bartholomews Hospital, West Smithfield, London, UK.
Malcolm
M
Finlay
Vinit
V
Sawhney
Richard
R
Schilling
Glyn
G
Thomas
Edward
E
Duncan
Ross
R
Hunter
Gurpreet
G
Virdi
Dominic
D
Abrams
Simon
S
Sporton
Mehul
M
Dhinoja
Mark
M
Earley
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics*; D001282:Atrial Flutter / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011292:Premedication / Q000191:economics* / Q000379:methods; D015995:Prevalence; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage* / Q000191:economics*
D000925:Anticoagulants; D014859:Warfarin