P2874Risk of peri-procedural thromboembolic events in patients on reduced dose of oral anticoagulants undergoing catheter ablation for atrial fibrillation

Abstract

Background: Current guidelines recommend a reduced dose regimen for the new oral anticoagulants (NOAC) in patients with certain indications. Objective: We report the incidence of thromboembolic events (TE) events in the immediate post-ablation period with standard versus reduced dose of NOAC in patients with indication for a reduced-dose, receiving ablation for atrial fibrillation (AF). Methods: Consecutive AF patients with at least two of the three main dose reduction criteria such as age ≥80, body weight ≤60 kg and serum creatinine >1.5 mg/dL were included in this analysis. Patients received either the standard or the reduced dose of apixaban or dabigatran or rivaroxaban based on the physician's discretion. Peri-procedural TE event was defined as onset of a new neurological deficit that occurred anytime within 48 hours of the ablation procedure; if the deficit lasted <24 hours it was defined as transient ischemic attack (TIA). If the deficit persisted for a longer period and resulted in a positive finding on computed tomography or magnetic resonance imaging, it was defined as a stroke. Results: A total of 348 patients [paroxysmal AF: 118 (34%)] with at least two of the 3 dose-reduction criteria were included in the analysis; 198 patients were 80 years or older, 146 had body weight <60 kg and 68 had serum creatinine >1.5 mg/dL. Of the 348 patients, 46 (paroxysmal AF: 13, non-paroxysmal AF: 33) received reduced dose of NOAC; remaining 303 patients were on standard dose. During the peri-procedural period, 5 TE events (one stroke and 4 TIA) were reported; all 5 events occurred in the non-paroxysmal AF patients receiving the reduced dose of NOAC (5/33, 15.1%). No TE events or periprocedural bleeding were detected in patients receiving the standard dose of the oral anticoagulants, irrespective of AF type. Also, there were no reported TE events in paroxysmal AF patients that remained on the reduced dose. Conclusion: Risk of thromboembolic events is higher with reduced dose of NOAC in non-paroxysmal AF patients. On the other hand, no peri-procedural bleeding or TE events were reported in patients receiving standard dose of the drug despite having indication for reduced dose.