P368New oral anticoagulants compared to acenocoumarol for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation

Abstract

Introduction: Thromboembolic complications can be life-threatening during atrial fibrillation (AF) catheter ablation. Uninterrupted oral anticoagulation during the procedure reduces thromboembolic complications but there is a risk of bleeding complications. Objective: We aimed to evaluate the safety and efficacy of continuous treatment using direct oral anticoagulants (DOACs) as an alternative to uninterrupted acenocoumarol for periprocedural anticoagulation in left atrial ablation procedures. Methods: We performed an observational, prospective study with consecutive patients undergoing AF ablation. The patients of our cohort were equally assigned to take acenocoumarol or DOACs for at least 2 months before the procedure. We compared thromboembolic and bleeding complications between patients taking periprocedural uninterrupted acenocoumarol (INR 2-3) with patients taking continuous treatment with DOACs. Patients were well matched by age, gender, BMI, LVEF, CHA2DS2-VASc and HASBLED scores. We considered as major complications thromboembolic events, pericardial effusions causing tamponade requiring pericardial drainage or major hemorrhagic complications causing hemodynamic collapse needing transfusion. Minor complications were pericardial infusion <1cm without hemodynamic compromise and hematomas or any bleeding event that did not require intervention. Our follow-up for periprocedural complications was 90 days. Results: Out of 474 patients prospectively assigned, 136 (28.7%) were treated with uninterrupted acenocoumarol (INR 2-3) and 338 patients (71.3%) with continuous oral anticoagulation. There was not a statistically significant difference in major (p=0.073) and minor complications (0.523) between the 2 groups. Our cohort was consisted of 110 (23.2%) patients treated with rivaroxaban 20 mg, 114 (24.1%) with apixaban 5 mg and 114 (24.1%) with dabigatran 110 mg. Three out of 136 patients (2.2%) using uninterrupted acenocoumarol had a major complication while 2 patients had minor complications (1.4%). In regard to the major complications, 1 patient had a TIA (0.7%) resolved 8 hours later, 1 (0.7%) had pericardial tamponade and 1 (0.7%) had subcapsular renal hematoma. In regard to minor complications, 1 patient had a pseudoaneurysm (0.7%) and 1 (0.7%) patient a groin hematoma. In the group of patients taking continuous anticoagulation with DOACs, 1 (0.3%) out of 338 patients had a major complication [TIA] while 10 (3%) patients had a minor complication [1 patient (0.3%) with pseudoanurysm, 7 (2.1%) with pericardial effusion <1cm, 1 (0.3%) with femoral AV fistula between femoral artery and femoral vein not requiring intervention resolved with compression and 1 (0.7%) had a groin hematoma]. Conclusion: DOACs has similar safety and effectiveness to acenocoumarol in preventing thromboembolic complications without increasing bleeding complications during the periprocedural period of AF ablation.