title: Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban.
abstract: OBJECTIVE
  Atrial fibrillation ablation requires peri-procedural oral anticoagulation (OAC) to prevent thromboembolic events. There are several options for OAC. We evaluate peri-procedural AF ablation complications using a variety of peri-procedural OACs.
  
  
  RESULTS
  We examined peri-procedural OAC and groin, bleeding, and thromboembolic complications for 2334 consecutive AF ablations using open irrigated-tip radiofrequency (RF) catheters. Pre-ablation OAC was warfarin in 1113 (47.7%), dabigatran 426 (18.3%), rivaroxaban 187 (8.0%), aspirin 472 (20.2%), and none 136 (5.8%). Oral anticoagulation was always interrupted and intraprocedural anticoagulation was unfractionated heparin (activated clotting time, ACT = 237 ± 26 s). Pre- and post-OAC drugs were the same for 1591 (68.2%) and were different for 743 (31.8%). Following ablation, 693 (29.7%) were treated with dabigatran and 291 (12.5%) were treated with rivaroxaban. There were no problems changing from one OAC pre-ablation to another post-ablation. Complications included 12 (0.51%) pericardial tamponades [no differences for dabigatran (P = 0.457) or rivaroxaban (P = 0.163) compared with warfarin], 12 (0.51%) groin complications [no differences for rivaroxaban (P = 0.709) and fewer for dabigatran (P = 0.041) compared with warfarin]. Only 5 of 2334 (0.21%) required blood transfusions. There were two strokes (0.086%) and no transient ischaemic attacks (TIAs) in the first 48 h post-ablation. Three additional strokes (0.13%), and two TIAs (0.086%) occurred from 48 h to 30 days. Only one stroke had a residual deficit. Compared with warfarin, the neurologic event rate was not different for dabigatran (P = 0.684) or rivaroxaban (P = 0.612).
  
  
  CONCLUSIONS
  Using interrupted OAC, low target intraprocedural ACT, and irrigated-tip RF, the rate of peri-procedural groin, haemorrhagic, and thromboembolic complications was extremely low. There were only minimal differences between OACs. Low-risk patients may remain on aspirin/no OAC pre-ablation. There are no problems changing from one OAC pre-ablation to another post-ablation.
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA rawinkle@aol.com.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA.
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA 94303, USA Sequoia Hospital, Redwood City, CA, USA.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery*; D001562:Benzimidazoles / Q000008:administration & dosage; D017115:Catheter Ablation / Q000295:instrumentation*; D003131:Combined Modality Therapy; D000069604:Dabigatran; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011846:Radio Waves; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D014859:Warfarin; D006493:Heparin; D000069552:Rivaroxaban; D000069604:Dabigatran; D001241:Aspirin
keywords: Ablation; Anticoagulation; Atrial fibrillation; Dabigatran; Rivaroxaban; Warfarin