title: Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  Experiences with novel oral anticoagulants (NOACs) early after atrial fibrillation (AF) catheter ablation are limited and show controversial results. We aimed to assess the longer-term safety, efficacy, and acceptance of NOACs in a large real-world cohort of patients presenting for AF catheter ablation.
  
  
  RESULTS
  From July 2010 until June 2012, 259 patients undergoing AF catheter ablation were prospectively included. Novel oral anticoagulants were given for at least 3 months post-ablation. Clinical outcome (stroke, thromboembolic events, major bleeding), adverse effects, and drug adherence were assessed at discharge and follow-up. On admission patients were presented with a variety of anticoagulants including 54 patients (21%) already on NOACs prior ablation. After ablation 38% of patients received dabigatran 110 mg, 56% 150 mg, and 6% received rivaroxaban 20 mg. There were four periprocedural thromboembolic and major bleeding complications (1.5%), all in patients without NOACs prior ablation (two on warfarin and two on heparin). During long-term follow-up [311 (199; 418) days] no stroke, systemic embolism, or major haemorrhage could be observed. Uneventful electrical cardioversions and reablation procedures were performed in 27 and 12 patients on dabigatran, respectively. Novel oral anticoagulants were prematurely stopped or switched to another anticoagulant due to side effects or at the preference of the treating general practitioner in 9 and 10 patients, respectively.
  
  
  CONCLUSIONS
  In this prospective observational study, anticoagulation with NOACs following AF catheter ablation was safe and effective at long-term follow-up. Fast onset of action makes NOACs especially attractive in patients without effective anticoagulation on admission and in patients following periprocedural complications.
authors.affiliation: Department of Electrophysiology, University of Leipzig, Heart Center, Strümpellstrasse 39, 04289 Leipzig, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.forename: Julia
authors.initials: J
authors.lastname: Koch
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Silke
authors.initials: S
authors.lastname: John
authors.forename: Simon
authors.initials: S
authors.lastname: Kircher
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D064792:Pragmatic Clinical Trials as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Catheter ablation; Dabigatran; Novel anticoagulants; Rivaroxaban