title: Immediate post-procedure bridging with unfractioned heparin versus low molecular weight heparin in patients undergoing radiofrequency ablation for atrial fibrillation with an interrupted oral anticoagulation strategy.
abstract: OBJECTIVE
  Many centers perform catheter ablation for atrial fibrillation (AF) with periprocedural interruption of oral vitamin K antagonists. In this scenario, the optimal post-procedural anticoagulation strategy is still under debate. We sought to compare the incidence of major complications associated with post-procedural use of low molecular weight heparin (LMWH) versus unfractioned heparin (UFH) as a bridge to reinitiation of oral anticoagulation after an AF ablation procedure.
  
  
  METHODS
  We retrospectively reviewed medical history data of all patients undergoing catheter ablation for AF at three Spanish referral centers between January 2009 and January 2014. A total of 702 patients were included in the analysis. We compared the incidence of major complications (a combination of major bleeding and thromboembolic events) between patients receiving UFH (291) and those receiving LMWH (411) after the procedure.
  
  
  RESULTS
  The overall incidence of major complications was 4.1%, including five thromboembolic events (0.7%) and 24 major bleeding events (3.4%), with no significant differences in patients treated with LMWH vs. UFH (2.9 vs. 4.1%; P = NS). The presence of peripheral vascular disease emerged as the only independent predictor of major complications (adjusted odds ratio (OR) 9.1; confidence interval (CI) 95% 1.7-49.3; P < 0.01).
  
  
  CONCLUSIONS
  Immediate post-procedural bridging with UFH or with LMWH are equally safe strategies in patients undergoing catheter ablation for AF in whom oral anticoagulation is interrupted for the procedure. Due to its greater simplicity of use, LMWH may be the preferred option. The presence of peripheral vascular disease is a potent predictor of major post-procedural complications.
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Loughlin
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain. tomas.datino@gmail.com.
authors.forename: Tomás Datino
authors.initials: TD
authors.lastname: Romaniega
authors.affiliation: Hospital Universitario Asistencial, Burgos, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Fernandez
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Calvo
authors.affiliation: Hospital Universitario Asistencial, Burgos, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Salgado
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Arenal
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: González-Torrecilla
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Atienza
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011292:Premedication; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
keywords: Anticoagulation; Atrial fibrillation; Heparin; Protamine; Radiofrequency ablation