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

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158 Scopus citations

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

Keywords

  • periprocedural anticoagulation
  • radiofrequency ablation
  • rivaroxaban
  • warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Lakkireddy, D., Reddy, Y. M., Di Biase, L., Vallakati, A., Mansour, M. C., Santangeli, P., Gangireddy, S., Swarup, V., Chalhoub, F., Atkins, D., Bommana, S., Verma, A., Sanchez, J. E., Burkhardt, J. D., Barrett, C. D., 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, 63(10), 982-988. https://doi.org/10.1016/j.jacc.2013.11.039