Prevention of periprocedural ischemic stroke and management of hemorrhagic complications in atrial fibrillation ablation under continuous warfarin administration.
BACKGROUND
This study aimed to determine the effects of continuing warfarin administration during the periprocedural period of catheter ablation for atrial fibrillation (AF) on the prevention of stroke complications and to evaluate the management of hemorrhagic complications occurring with this approach.


RESULTS
A total of 3,280 patients undergoing AF catheter ablation at our institution were divided into 2 groups: the first 1,953 patients who discontinued warfarin 3-4 days before AF ablation and were bridged with heparin (warfarin-discontinued group), and the last 1,327 patients who continued warfarin throughout the periprocedural period (warfarin-continued group). Symptomatic stroke or transient ischemic attack occurred in 13/1,953 patients (0.67%) in the warfarin-discontinued group and in 2/1,327 patients (0.15%) in the warfarin-continued group (P = 0.021). None of the patients with therapeutic international normalized ratio at the time of the procedure had periprocedural thromboembolism in the warfarin-continued group. Major hemorrhagic complications occurred in 26/1,953 patients in the warfarin-discontinued group (1.3%; 25 with cardiac tamponade and 1 with retroperitoneal bleeding), and in 15/1,327 patients in the warfarin-continued group (1.1%; 14 with cardiac tamponade and 1 with abdominal wall bleeding) (P = 0.80). Of the 14 warfarin-continued patients with cardiac tamponade, 13 were administered prothrombin complex concentrate (PCC) and vitamin K; the bleeding was stopped safely without surgical repair.


CONCLUSIONS
The continuation of warfarin during the periprocedural period of AF ablation could reduce the incidence of stroke without increasing hemorrhagic complications. When cardiac tamponade occurred with this approach, it was safely treated with PCC and vitamin K.
Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan. dr.kuwahara@gmail.com
Taishi
T
Kuwahara
Atsushi
A
Takahashi
Yoshihide
Y
Takahashi
Atushi
A
Kobori
Shinsuke
S
Miyazaki
Asumi
A
Takei
Tadashi
T
Fujino
Kenji
K
Okubo
Katsumasa
K
Takagi
Akira
A
Fujii
Masateru
M
Takigawa
Yuji
Y
Watari
Hiroyuki
H
Hikita
Akira
A
Sato
Kazutaka
K
Aonuma
D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D020521:Stroke / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin