Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study.
BACKGROUND
Periprocedural anticoagulation management with uninterrupted warfarin and a "therapeutic" international normalized ratio is the best approach for reducing both thromboembolic and bleeding complications in the setting of catheter ablation for atrial fibrillation (AF).


OBJECTIVE
The purpose of this study was to evaluate the safety and feasibility of uninterrupted apixaban in this setting.


METHODS
This was a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation at 4 institutions in United States and Europe with uninterrupted apixaban. These patients were compared with an equal number of patients, matched for age, gender, and type of AF, undergoing AF ablation on uninterrupted warfarin. The apixaban group was comprised of consecutive patients who had taken their last dose of apixaban the morning of the procedure. A subset of 29 patients in the apixaban group underwent diffusion magnetic resonance imaging (dMRI) to detect silent cerebral ischemia.


RESULTS
A total of 400 patients (200 patients in each group) were included in the study. The average age was 65.9 ± 9.9 years, 286 (71.5%) were male, and 334 (83.5%) had nonparoxysmal AF. There were no statistical differences with regard to major complications (1% vs 0.5%, P = 1), minor complications (3.5% vs 2.5%, P = .56), or total bleeding complications (4.5% vs 3%, P = .43) between the apixaban and warfarin groups. There were no symptomatic thromboembolic complications. All dMRIs were negative for "new" silent cerebral ischemia in the apixaban group.


CONCLUSIONS
Uninterrupted apixaban administration in patients undergoing AF ablation seems to be feasible and effective in preventing clinical and silent thromboembolic events without increasing the risk of major bleeding.
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
Luigi
L
Di Biase
Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
Dhanujaya
D
Lakkireddy
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Chintan
C
Trivedi
Klinik für Kardiologie mit interventioneller Elektrophysiologie, Herz- und Gefäßklinik Bad Neustadt a. d. Saale, Bad Neustadt a. d. Saale, Germany.
Thomas
T
Deneke
Elisabehinen University Teaching Hospital Linz, Linz, Austria.
Martin
M
Martinek
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Sanghamitra
S
Mohanty
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Prasant
P
Mohanty
Texas College of Osteopathic Medicine, Fort worth, Texas.
Sameer
S
Prakash
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Rong
R
Bai
Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
Madhu
M
Reddy
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Carola
C
Gianni
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Rodney
R
Horton
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Shane
S
Bailey
Elisabehinen University Teaching Hospital Linz, Linz, Austria.
Elisabeth
E
Sigmund
Elisabehinen University Teaching Hospital Linz, Linz, Austria.
Michael
M
Derndorfer
Klinik für Kardiologie mit interventioneller Elektrophysiologie, Herz- und Gefäßklinik Bad Neustadt a. d. Saale, Bad Neustadt a. d. Saale, Germany.
Anja
A
Schade
Klinik für Kardiologie mit interventioneller Elektrophysiologie, Herz- und Gefäßklinik Bad Neustadt a. d. Saale, Bad Neustadt a. d. Saale, Germany.
Patrick
P
Mueller
Klinik für Kardiologie mit interventioneller Elektrophysiologie, Herz- und Gefäßklinik Bad Neustadt a. d. Saale, Bad Neustadt a. d. Saale, Germany.
Atilla
A
Szoelloes
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Javier
J
Sanchez
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Amin
A
Al-Ahmad
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
Patrick
P
Hranitzky
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
G Joseph
GJ
Gallinghouse
California Pacific Medical Center, San Francisco, California.
Richard H
RH
Hongo
California Pacific Medical Center, San Francisco, California.
Salwa
S
Beheiry
Elisabehinen University Teaching Hospital Linz, Linz, Austria.
Helmut
H
Pürerfellner
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
J David
JD
Burkhardt
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Stanford, California; Case Western Reserve University, Cleveland, Ohio; Interventional Electrophysiology, Scripps Clinic, San Diego, California. Electronic address: dr.natale@gmail.com.
Andrea
A
Natale
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage*; D011728:Pyridones / Q000008:administration & dosage*; D012449:Safety; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin
Anticoagulant; Atrial fibrillation; Catheter ablation; Silent thromboembolic lesion; Stroke; Warfarin