title: Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation.
  
  
  BACKGROUND
  Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown.
  
  
  METHODS
  We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period.
  
  
  RESULTS
  A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days.
  
  
  CONCLUSIONS
  Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas. Electronic address: dlakkireddy@kumc.edu.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Yeruva Madhu
authors.initials: YM
authors.lastname: Reddy
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy; Department of Biomedical Engineering, University of Texas, Austin, Texas.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Moussa C
authors.initials: MC
authors.lastname: Mansour
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Mount Sinai Medical Center, New York, New York.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gangireddy
authors.affiliation: Arizona Heart Rhythm Center, Phoenix, Arizona.
authors.forename: Vijay
authors.initials: V
authors.lastname: Swarup
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Fadi
authors.initials: F
authors.lastname: Chalhoub
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.affiliation: Southlake Regional Medical Center, Toronto, Ontario, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas.
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: St. Lukes Roosevelt Hospital, New York, New York.
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.affiliation: California Pacific Medical Center, San Francisco, California.
authors.forename: Salwa
authors.initials: S
authors.lastname: Baheiry
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ruskin
authors.affiliation: Arizona Heart Rhythm Center, Phoenix, Arizona.
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Texas Cardiac Arrhythmia Institute, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D065427:Factor Xa Inhibitors; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage*; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban
keywords: periprocedural anticoagulation; radiofrequency ablation; rivaroxaban; warfarin