title: Comparative study of hemorrhagic and ischemic complications among anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation.
abstract: Few data exist to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) undergoing cryoballoon ablation (CB-A). This study is aimed to clarify the usefulness of DOACs in patients undergoing CB-A.
  
  
  
  The patients (average age; 65.8±11.9 years old, male 69%) were stratified into one of five subsets based on the type of anticoagulation (warfarin, apixaban, dabigatran, rivaroxaban, or edoxaban), and underwent CB-A. A brain MRI was performed in all patients the day after the CB-A for AF. A total of 257 (19 on warfarin, 30 on apixaban, 66 on dabigatran, 81 on rivaroxaban, and 61 on edoxaban) patients met the inclusion criteria.
  
  
  
  The incidence of silent cerebral ischemic lesion was 1 (11.1%) patients on warfarin, 5 (33.3%) on apixaban, 8 (27.6%) on dabigatran, 10 (21.3%) on rivaroxaban, and 10 (29.4%) on edoxaban (p=0.17). Major ischemic events occurred in one patient (1.6%) on edoxaban and one (5.3%) on warfarin. Minor bleeding complications occurred in 1 patient (5.3%) on warfarin, 2 (6.7%) on apixaban, 1 (1.2%) on rivaroxaban, 5 (7.6%) on dabigatran, and 2 (3.3%) on edoxaban (p=0.24). Of note, major bleeding complications occurred in 2 patients (3.3%) on apixaban, 1 (1.2%) on rivaroxaban, 1 (1.5%) on dabigatran, 1 (1.6%) on edoxaban, and 2 (10.5%) on warfarin (p<0.05).
  
  
  
  Warfarin use significantly increased the risk of serious bleeding, in contrast, CB-A did not place the patients at an increased risk of complications under a DOAC treatment. There were no significant differences regarding preventing embolic events among the DOAC drugs.
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan. Electronic address: okishige@yo.rim.or.jp.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Hideshi
authors.initials: H
authors.lastname: Aoyagi
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kawaguchi
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Mitsumi
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kurabayashi
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Asano
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Shimura
authors.affiliation: Heart Center, Yokohama-city Bay Red Cross Hospital, Yokohama City, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sasano
authors.affiliation: Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003452:Cryosurgery / Q000009:adverse effects*; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D004617:Embolism / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban
keywords: Anticoagulant; Atrial fibrillation; Cerebral infarction; Cryoballoon