title: Preprocedural therapeutic international normalized ratio influence on bleeding complications in atrial fibrillation ablation with continued anticoagulation with warfarin.
abstract: BACKGROUND
  Safety of atrial fibrillation (AF) ablation in conditions of periprocedural therapeutic international normalized ratio (INR) in combination with heparin is still uncertain, and little is known about the pre-procedural therapeutic INR influence on bleeding complications (BC) in this method.
  
  
  RESULTS
  The subjects were 150 consecutive patients who underwent catheter ablation for AF with therapeutic INR. The patients were classified into 2 groups, BC (Group BC) and no BC (Group No BC), by whether they did or did not have BC, respectively. Differences in various parameters, including pre- and post-procedural prothrombin time-INR and activated partial thromboplastin time (APTT), were compared between the 2 groups. None of the patients experienced stroke or transient ischemic attack. In the 22 patients (15%) who had BC (Group BC), 3 patients had major and 19 patients had minor BC. There were no significant differences between the 2 groups in pre-procedural INR, APTT, and amount of heparin administered during the procedure. However, post-procedural INR and APTT were significantly prolonged in Group BC (2.5 ± 0.5 vs. 2.2 ± 0.5, P=0.016, 65 ± 45 vs. 44 ± 11, P<0.0001 respectively). Multivariable analysis showed that post-procedural APTT was the only independent bleeding risk factor (P=0.022).
  
  
  CONCLUSIONS
  AF ablation with peri-procedural therapeutic INR in combination with heparin seems to be safe. Presence or absence of BC are not related to the pre-procedural INR level, but to post-procedural APTT.
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan. star_platinum_21@yahoo.co.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Hayashi
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Koji
authors.initials: K
authors.lastname: Goto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kaseno
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohshima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D007431:Intraoperative Complications / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011479:Protamines / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D006494:Heparin Antagonists; D011479:Protamines; C036309:fibrin fragment D; D014859:Warfarin; D006493:Heparin