title: Safety of ablation for atrial fibrillation with therapeutic INR: comparison with transition to low-molecular-weight heparin.
abstract: BACKGROUND
  The ideal management of oral anticoagulation (OAC) before and after catheter ablation for atrial fibrillation (AF) is still controversial.
  
  
  OBJECTIVE
  To compare two anticoagulation strategies for catheter ablation for AF: warfarin withholding and use of low-molecular-weight heparin (LMWH); and maintenance of warfarin and therapeutic INR (between 2.0 and 3.0).
  
  
  METHODS
  140 patients (pt) with persistent/permanent AF undergoing catheter ablation for AF were divided into two groups: Group I (70 pt), in which warfarin was withheld five days prior to the procedure and transition to LMWH was used (enoxaparin: 1 mg/kg 2x/day before ablation, and 0.5 mg/kg 2x/day after ablation); Group II (70 pt), in which warfarin was not withheld and the procedure was performed with therapeutic INR. Both groups received intravenous heparin (ACT > 350 seconds) during ablation.
  
  
  RESULTS
  In Group I, one pt (1.4%) had a major hemorrhagic complication and four pts (5.7%) had minor hemorrhagic complications. In Group II, two pts (2.8%) had minor hemorrhagic complications and one pt had a major bleeding, which occurred after using LMWH due to INR < 2.0. None of the groups had thromboembolic complications or cardiovascular death over a period of 16 ± 8 months.
  
  
  CONCLUSIONS
  Catheter ablation for AF without withholding OAC and with therapeutic INR is a strategy that has similar safety and efficacy when compared with the traditional transition to LMWH, avoiding the potentially inadequate anticoagulation of the initial post-ablation period.
authors.affiliation: Centro de Fibrilação Atrial, Setor de Arritmia Invasiva, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil. eduardobsaad@hotmail.com
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Saad
authors.forename: Ieda P
authors.initials: IP
authors.lastname: Costa
authors.forename: Rodrigo E da
authors.initials: RE
authors.lastname: Costa
authors.forename: Luiz Antôniuo O
authors.initials: LA
authors.lastname: Inácio
authors.forename: Charles
authors.initials: C
authors.lastname: Slater
authors.forename: Angelina
authors.initials: A
authors.lastname: Camiletti
authors.forename: Dario G de
authors.initials: DG
authors.lastname: Moura Neto
authors.forename: Paulo
authors.initials: P
authors.lastname: Maldonado
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Camanho
authors.forename: Carisi A
authors.initials: CA
authors.lastname: Polanczky
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin