title: Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: a safe and efficacious periprocedural anticoagulation strategy.
abstract: BACKGROUND
  The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR).
  
  
  METHODS
  Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (> or =1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications.
  
  
  RESULTS
  Mean INR was 2.53 +/- 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3).
  
  
  CONCLUSIONS
  In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.
authors.affiliation: Center for Atrial Fibrillation, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Deven
authors.initials: D
authors.lastname: Patel
authors.forename: Saima
authors.initials: S
authors.lastname: Karim
authors.forename: Omar
authors.initials: O
authors.lastname: Batal
authors.forename: Mustafa
authors.initials: M
authors.lastname: Banna
authors.forename: Michelle
authors.initials: M
authors.lastname: Williams-Andrews
authors.forename: Minerva
authors.initials: M
authors.lastname: Sherman
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Thomas
authors.initials: T
authors.lastname: Dresing
authors.forename: Thomas
authors.initials: T
authors.lastname: Callahan
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Bruce
authors.initials: B
authors.lastname: Lindsay
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery; D020521:Stroke / Q000139:chemically induced; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin