A comparison of bleeding complications between warfarin, dabigatran, and rivaroxaban in patients undergoing cryoballoon ablation.
BACKGROUND
In recent years, several novel anticoagulants have been approved for the prevention of thromboembolic strokes as an alternative to warfarin in patients with atrial arrhythmias. Studies have evaluated these medications in patients undergoing radiofrequency ablation, yet no data exists to evaluate the bleeding risk in patients undergoing cryoballoon ablation procedures.


METHODS
Patients that underwent either cryoballoon ablation alone or with additional radiofrequency ablation over the past 3 years were included in the study. Patients were stratified into one of three subsets based on type of anticoagulation (warfarin, dabigatran, or rivaroxaban). Bleeding complications during the first 48 h and first 2 weeks following the ablation were recorded. Major complications were defined as hemorrhage requiring blood products or need for vascular intervention. Minor complications included prolonged bleeding from catheter insertion site, development of ecchymosis, or hematoma formation. Intraprocedural activated clotting times (ACT) were assessed and compared.


RESULTS
A total of 217 patients met inclusion criteria of which 87 (40.1 %) patients were on warfarin, 90 (41.5 %) patients on dabigatran, and 40 (18.4 %) patients on rivaroxaban. The overall bleeding complication rate was 12.0 %. All complications occurred within the first 48 h post-ablation. Nine (10.3 %) complications occurred in the warfarin subset, ten (11.1 %) in the rivaroxaban subset, and seven (17.5 %) in the dabigatran subset (p = 0.49). The warfarin and dabigatran subsets had higher average ACT levels (424.9 versus 406.5) compared to the rivaroxaban subset (393.4; p < 0.01). Subanalyses found no difference in bleeding complications based on procedure type.


CONCLUSIONS
Bleeding complications post-ablation were similar for warfarin, dabigatran, and rivaroxaban in patients undergoing cryoballoon ablation. Compared with radiofrequency ablation, cryoablation does not place patients at an increased bleeding risk.
Department of Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, snipelisky.david@mayo.edu.
David
D
Snipelisky
Jordan C
JC
Ray
Ryan
R
Ung
Melissa
M
Duart
Christine
C
Kauffman
Fred
F
Kusumoto
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D017115:Catheter Ablation / Q000009:adverse effects; D015897:Comorbidity; D003452:Cryosurgery / Q000009:adverse effects*; D000069604:Dabigatran; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D015994:Incidence; D008297:Male; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D000069552:Rivaroxaban; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran