title: Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study.
abstract: Stroke can be a life-threatening complication of atrial fibrillation (AF) catheter ablation. Uninterrupted warfarin treatment contributes to minimizing the risk of stroke complications.
  
  
  
  This was a prospective, open-label, randomized, multicenter study assessing the safety and efficacy of apixaban for the prevention of cerebral thromboembolism complicating AF catheter ablation. Two hundred patients with drug-resistant AF were equally assigned to take either apixaban (5 mg or 2.5 mg twice daily) or warfarin (target international normalized ratio, 2-3) for at least 1 month before AF ablation. Neither drug regimen was interrupted throughout the operative period. Diffusion-weighted magnetic resonance imaging was performed for all patients to detect silent cerebral infarction (SCI) after the ablation. Primary outcomes were defined as the occurrence of stroke, transient ischemic attack, SCI, or major bleeding that required intervention. The secondary outcome was minor bleeding. The groups did not statistically differ in patients' backgrounds or procedural parameters. During AF ablation, the apixaban group required administration of more heparin to maintain an activated clotting time > 300 seconds than the warfarin group (apixaban, 14,000 ± 4,000 units; warfarin, 9,000 ± 3,000 units). Three primary outcome events occurred in each group (apixaban, 2 SCI and 1 major bleed; warfarin, 3 SCI, P = 1.00), and 3 and 4 secondary outcome events occurred in the apixaban and warfarin groups (P = 0.70), respectively.
  
  
  
  Apixaban has similar safety and effectiveness to warfarin for the prevention of cerebral thromboembolism during the periprocedural period of AF ablation.
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.affiliation: Yotsuba Circulation Clinic, Matsuyama, Ehime, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Cardiovascular Division, Nayoro General Hospital, Nayoro, Hokkaido, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Yamaki
authors.affiliation: Yotsuba Circulation Clinic, Matsuyama, Ehime, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujieda
authors.affiliation: Yotsuba Circulation Clinic, Matsuyama, Ehime, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Yotsuba Circulation Clinic, Matsuyama, Ehime, Japan.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Cardiovascular Division, Nayoro General Hospital, Nayoro, Hokkaido, Japan.
authors.forename: Misako
authors.initials: M
authors.lastname: Ishiba
authors.affiliation: Cardiovascular Division, Nayoro General Hospital, Nayoro, Hokkaido, Japan.
authors.forename: Hirotsuka
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hishikari
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001777:Blood Coagulation / Q000187:drug effects; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D016903:Drug Monitoring / Q000379:methods; D065427:Factor Xa Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin
keywords: anticoagulant; apixaban; atrial fibrillation; catheter ablation; silent cerebral infarction; stroke; warfarin