title: Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation.
abstract: BACKGROUND
  The new oral anticoagulants (NOAC), dabigatran and rivaroxaban, have been demonstrated to be at least equivalent to warfarin for preventing cardiac thromboembolism (TE) in patients with atrial fibrillation (AF). However, there is limited data regarding use around catheter ablation (CA) procedures.
  
  
  OBJECTIVE
  We evaluated the risk of bleeding and TE complications associated with NOAC use during AF ablation.
  
  
  METHODS
  Consecutive patients undergoing AF ablation between January 2011 and 6 September 2013 were grouped based on peri-procedural anticoagulation regimen: (1) uninterrupted warfarin with therapeutic INR (WARF), n = 114, (2) dabigatran, n = 89, or (3) rivaroxaban, n = 98. NOACs were held for 24 h (dabigatran) or 36 h (rivaroxaban) prior to the procedure. Heparin infusion was initiated 6 h post-procedure for the NOAC groups; NOACs were resumed the morning after the procedure. Antral PVI was performed with activated clotting time (ACT) maintained >300 s. TE or bleeding complications during ablation and through 30 days were compared.
  
  
  RESULTS
  Three hundred and one patients underwent ablation for paroxysmal (71%) or persistent (29%) AF. International Normalization Ratio (INR) for the WARF group was 2.0 ± 0.5. Baseline characteristics were similar among the groups. There were two TE events (asymptomatic cerebral emboli and TIA), and there were 17 bleeding events (large hematoma n = 4; pericardial effusion n = 6; persistent hematuria n = 1; pseudoaneurism/AV fistula n = 6). Of the six pericardial effusions, three required drainage. There was no significant difference in combined TE/bleeding risk among the groups (WARF vs. dabigatran vs. rivaroxaban; 6.2% vs. 6.7% vs. 6.0%; p = 0.82) CONCLUSIONS: In this group of AF patients undergoing CA, use of peri-procedure dabigatran or rivaroxaban compared to uninterrupted warfarin did not lead to an increase in bleeding or TE complications.
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, San Francisco, 500 Parnassus Avenue, MU, San Francisco, CA, 94143, USA.
authors.forename: Gevorg
authors.initials: G
authors.lastname: Stepanyan
authors.forename: Nitish
authors.initials: N
authors.lastname: Badhwar
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Lee
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
authors.forename: Byron K
authors.initials: BK
authors.lastname: Lee
authors.forename: Zian H
authors.initials: ZH
authors.lastname: Tseng
authors.forename: Vasanth
authors.initials: V
authors.lastname: Vedantham
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Olgin
authors.forename: Melvin
authors.initials: M
authors.lastname: Scheinman
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D001562:Benzimidazoles / Q000627:therapeutic use*; D017115:Catheter Ablation; D000069604:Dabigatran; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D011667:Pulmonary Veins / Q000601:surgery; D012189:Retrospective Studies; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use*; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran