Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: Results from a multicenter prospective registry

Dhanunjaya Lakkireddy, Yeruva Madhu Reddy, Luigi Di Biase, Ajay Vallakati, Moussa C. Mansour, Pasquale Santangeli, Sandeep Gangireddy, Vijay Swarup, Fadi Chalhoub, Donita Atkins, Sudharani Bommana, Atul Verma, Javier E. Sanchez, J. David Burkhardt, Conor D. Barrett, Salwa Baheiry, Jeremy Ruskin, Vivek Reddy, Andrea Natale

Research output: Contribution to journalArticle

148 Citations (Scopus)

Abstract

Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.

Original languageEnglish (US)
Pages (from-to)982-988
Number of pages7
JournalJournal of the American College of Cardiology
Volume63
Issue number10
DOIs
StatePublished - Mar 18 2014
Externally publishedYes

Fingerprint

Atrial Fibrillation
Registries
Safety
Warfarin
Hemorrhage
Therapeutics
Renal Hypertension
International Normalized Ratio
Rivaroxaban
Transient Ischemic Attack
North America
Anticoagulants
Observational Studies
Stroke
Alcohols
Prospective Studies
Liver
Pharmaceutical Preparations

Keywords

  • periprocedural anticoagulation
  • radiofrequency ablation
  • rivaroxaban
  • warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation : Results from a multicenter prospective registry. / Lakkireddy, Dhanunjaya; Reddy, Yeruva Madhu; Di Biase, Luigi; Vallakati, Ajay; Mansour, Moussa C.; Santangeli, Pasquale; Gangireddy, Sandeep; Swarup, Vijay; Chalhoub, Fadi; Atkins, Donita; Bommana, Sudharani; Verma, Atul; Sanchez, Javier E.; Burkhardt, J. David; Barrett, Conor D.; Baheiry, Salwa; Ruskin, Jeremy; Reddy, Vivek; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 63, No. 10, 18.03.2014, p. 982-988.

Research output: Contribution to journalArticle

Lakkireddy, D, Reddy, YM, Di Biase, L, Vallakati, A, Mansour, MC, Santangeli, P, Gangireddy, S, Swarup, V, Chalhoub, F, Atkins, D, Bommana, S, Verma, A, Sanchez, JE, Burkhardt, JD, Barrett, CD, Baheiry, S, Ruskin, J, Reddy, V & Natale, A 2014, 'Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: Results from a multicenter prospective registry', Journal of the American College of Cardiology, vol. 63, no. 10, pp. 982-988. https://doi.org/10.1016/j.jacc.2013.11.039
Lakkireddy, Dhanunjaya ; Reddy, Yeruva Madhu ; Di Biase, Luigi ; Vallakati, Ajay ; Mansour, Moussa C. ; Santangeli, Pasquale ; Gangireddy, Sandeep ; Swarup, Vijay ; Chalhoub, Fadi ; Atkins, Donita ; Bommana, Sudharani ; Verma, Atul ; Sanchez, Javier E. ; Burkhardt, J. David ; Barrett, Conor D. ; Baheiry, Salwa ; Ruskin, Jeremy ; Reddy, Vivek ; Natale, Andrea. / Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation : Results from a multicenter prospective registry. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 10. pp. 982-988.
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abstract = "Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69{\%}) males and 328 (51{\%}) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3{\%}) and 2 (0.3{\%}) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6{\%}] vs. 7 [1.9{\%}], respectively; p = 0.772), minor bleeding complications (16 [5.0{\%}] vs. 19 [5.9{\%}], respectively; p = 0.602), or embolic complications (1 [0.3{\%}] vs. 1 [0.3{\%}], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.",
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author = "Dhanunjaya Lakkireddy and Reddy, {Yeruva Madhu} and {Di Biase}, Luigi and Ajay Vallakati and Mansour, {Moussa C.} and Pasquale Santangeli and Sandeep Gangireddy and Vijay Swarup and Fadi Chalhoub and Donita Atkins and Sudharani Bommana and Atul Verma and Sanchez, {Javier E.} and Burkhardt, {J. David} and Barrett, {Conor D.} and Salwa Baheiry and Jeremy Ruskin and Vivek Reddy and Andrea Natale",
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T1 - Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation

T2 - Results from a multicenter prospective registry

AU - Lakkireddy, Dhanunjaya

AU - Reddy, Yeruva Madhu

AU - Di Biase, Luigi

AU - Vallakati, Ajay

AU - Mansour, Moussa C.

AU - Santangeli, Pasquale

AU - Gangireddy, Sandeep

AU - Swarup, Vijay

AU - Chalhoub, Fadi

AU - Atkins, Donita

AU - Bommana, Sudharani

AU - Verma, Atul

AU - Sanchez, Javier E.

AU - Burkhardt, J. David

AU - Barrett, Conor D.

AU - Baheiry, Salwa

AU - Ruskin, Jeremy

AU - Reddy, Vivek

AU - Natale, Andrea

PY - 2014/3/18

Y1 - 2014/3/18

N2 - Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.

AB - Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.

KW - periprocedural anticoagulation

KW - radiofrequency ablation

KW - rivaroxaban

KW - warfarin

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