title: Continuous warfarin therapy is safe and feasible in catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  In the context of catheter ablation of atrial fibrillation, oral anticoagulant therapy has been traditionally replaced by bridging with heparin during the periprocedural period. We wanted to study the feasibility and safety of continuous warfarin therapy compared to traditional bridging therapy.
  
  
  METHODS
  The complication rates were compared retrospectively in a consecutive patient series. In the bridging group, warfarin was discontinued three days and low molecular weight heparin started one day prior to the procedure. Warfarin was reinitiated one day after and low molecular weight heparin was continued until the therapeutic INR target was reached. Patients on continuous therapy received warfarin throughout the periprocedural period. All patients received unfractionated heparin during the procedure.
  
  
  RESULTS
  Three thromboembolic cerebrovascular events (1.9%) occurred in the bridging group (n = 157) and seven (0.82%) in the warfarin group (n = 850) (p = 0.142). The number of cardiac tamponades was one (0.64%) and four (0.47%), respectively (p = 0.786). Total number of severe bleeding and thromboembolic complications was more common in the bridging group: 9 (5.7%) versus 22 (2.6%); p = 0.036. In multivariate analysis, female gender, advanced age, and bridging therapy predicted complications.
  
  
  CONCLUSIONS
  Continuous oral anticoagulant therapy is a safe and feasible alternative for bridging therapy in patients undergoing catheter ablation of atrial fibrillation.
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. jari.tapanainen@karolinska.se
authors.forename: Jari M
authors.initials: JM
authors.lastname: Tapanainen
authors.forename: Frieder
authors.initials: F
authors.lastname: Braunschweig
authors.forename: Jonas
authors.initials: J
authors.lastname: Schwieler
authors.forename: Per
authors.initials: P
authors.lastname: Insulander
authors.forename: Hamid
authors.initials: H
authors.lastname: Bastani
authors.forename: Nicola
authors.initials: N
authors.lastname: Drca
authors.forename: Göran
authors.initials: G
authors.lastname: Kennebäck
authors.forename: Bita
authors.initials: B
authors.lastname: Sadigh
authors.forename: Mats
authors.initials: M
authors.lastname: Jensen-Urstad
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery*; D002305:Cardiac Tamponade / Q000209:etiology; D017115:Catheter Ablation; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D020767:Intracranial Thrombosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin