Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study

Luigi Di Biase, Dhanujaya Lakkireddy, Chintan Trivedi, Thomas Deneke, Martin Martinek, Sanghamitra Mohanty, Prasant Mohanty, Sameer Prakash, Rong Bai, Madhu Reddy, Carola Gianni, Rodney Horton, Shane Bailey, Elisabeth Sigmund, Michael Derndorfer, Anja Schade, Patrick Mueller, Atilla Szoelloes, Javier Sanchez, Amin Al-AhmadPatrick Hranitzky, G. Joseph Gallinghouse, Richard H. Hongo, Salwa Beheiry, Helmut Pürerfellner, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

99 Scopus citations

Abstract

Background Periprocedural anticoagulation management with uninterrupted warfarin and a "therapeutic" international normalized ratio is the best approach for reducing both thromboembolic and bleeding complications in the setting of catheter ablation for atrial fibrillation (AF). Objective The purpose of this study was to evaluate the safety and feasibility of uninterrupted apixaban in this setting. Methods This was a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation at 4 institutions in United States and Europe with uninterrupted apixaban. These patients were compared with an equal number of patients, matched for age, gender, and type of AF, undergoing AF ablation on uninterrupted warfarin. The apixaban group was comprised of consecutive patients who had taken their last dose of apixaban the morning of the procedure. A subset of 29 patients in the apixaban group underwent diffusion magnetic resonance imaging (dMRI) to detect silent cerebral ischemia. Results A total of 400 patients (200 patients in each group) were included in the study. The average age was 65.9 ± 9.9 years, 286 (71.5%) were male, and 334 (83.5%) had nonparoxysmal AF. There were no statistical differences with regard to major complications (1% vs 0.5%, P = 1), minor complications (3.5% vs 2.5%, P =.56), or total bleeding complications (4.5% vs 3%, P =.43) between the apixaban and warfarin groups. There were no symptomatic thromboembolic complications. All dMRIs were negative for "new" silent cerebral ischemia in the apixaban group. Conclusion Uninterrupted apixaban administration in patients undergoing AF ablation seems to be feasible and effective in preventing clinical and silent thromboembolic events without increasing the risk of major bleeding.

Original languageEnglish (US)
Pages (from-to)1162-1168
Number of pages7
JournalHeart Rhythm
Volume12
Issue number6
DOIs
StatePublished - Jun 1 2015

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Keywords

  • Anticoagulant
  • Atrial fibrillation
  • Catheterablation
  • Silentthromboemboliclesion
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Di Biase, L., Lakkireddy, D., Trivedi, C., Deneke, T., Martinek, M., Mohanty, S., Mohanty, P., Prakash, S., Bai, R., Reddy, M., Gianni, C., Horton, R., Bailey, S., Sigmund, E., Derndorfer, M., Schade, A., Mueller, P., Szoelloes, A., Sanchez, J., ... Natale, A. (2015). Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study. Heart Rhythm, 12(6), 1162-1168. https://doi.org/10.1016/j.hrthm.2015.02.028