When is it appropriate to stop non-vitamin K antagonist oral anticoagulants before catheter ablation of atrial fibrillation? A multicentre prospective randomized study.

Abstract:

AIMS:Although a recent expert consensus statement has recommended periprocedural uninterrupted (UI) non-vitamin K antagonist oral anticoagulants (NOACs) during catheter ablation of atrial fibrillation (AF) as a Class I indication, there have been no clear randomized trials. We investigated the safety and efficacy of UI, procedure day single-dose skipped (SDS), and 24-hour skipped (24S) NOACs in patients undergoing AF ablation. METHODS AND RESULTS:In this prospective, open-label, randomized multicentre trial, 326 patients (75% male, 58 ± 11 years old) scheduled for AF catheter ablation were randomly assigned in a 1:1:1 ratio to UI, SDS, and 24S at three tertiary hospitals. Bridging with low molecular weight heparin was carried out in the patients with persistent AF who were assigned to the 24S group. Dabigatran, rivaroxaban, and apixaban were assigned in order after randomization. The primary endpoint was the incidence of bleeding events within 1 month after ablation. The secondary endpoints included thrombo-embolic and other procedure-related complications. The intra-procedural heparin requirement was higher in the 24S group than others (P < 0.001), and the mean activated clotting time was comparable among the groups (P = 0.139). The incidence of major bleeding up to 1 month after ablation and a post-procedural reduction in the haemoglobin levels did not significantly differ among the treatment groups and different NOACs (P > 0.05). There were no fatal events or thrombo-embolic complications in all the three groups. CONCLUSION:In patients undergoing AF ablation, UI NOACs and SDS or double dose skipped NOACs had a comparable efficacy and safety, regardless of the type of NOAC.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Yu HT,Shim J,Park J,Kim TH,Uhm JS,Kim JY,Joung B,Lee MH,Kim YH,Pak HN

doi

10.1093/eurheartj/ehy870

subject

Has Abstract

pub_date

2019-05-14 00:00:00

pages

1531-1537

issue

19

eissn

0195-668X

issn

1522-9645

pii

5263768

journal_volume

40

pub_type

杂志文章,多中心研究,随机对照试验
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    authors: Alvarez L,Escudero C,Alzueta J,Silva L,Márquez-Montes J,Castillo-Olivares JL

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    doi:10.1093/oxfordjournals.eurheartj.a014717

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    更新日期:1996-10-01 00:00:00

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    更新日期:1983-01-01 00:00:00

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    journal_title:European heart journal

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    doi:10.1053/euhj.2000.2245

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    pub_type: 杂志文章

    doi:10.1093/eurheartj/15.suppl_d.88

    authors: Holubarsch C,Schmidt-Schweda S,Knorr A,Duis J,Pieske B,Ruf T,Fasol R,Hasenfuss G,Just H

    更新日期:1994-12-01 00:00:00

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    更新日期:1987-09-01 00:00:00

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    pub_type: 杂志文章

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    更新日期:1988-02-01 00:00:00

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    pub_type: 杂志文章,评审

    doi:10.1093/eurheartj/9.suppl_f.29

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    更新日期:1988-04-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1093/eurheartj/ehx156

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    更新日期:2017-07-14 00:00:00

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    pub_type: 杂志文章

    doi:

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    更新日期:2011-06-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/oxfordjournals.eurheartj.a060841

    authors: Hoffmann R,Lethen H,Flachskampf FA,Hanrath P

    更新日期:1995-12-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1016/j.ehj.2003.08.020

    authors: Giusti B,Porciani MC,Brunelli T,Evangelisti L,Fedi S,Gensini GF,Abbate R,Sani G,Yacoub M,Pepe G

    更新日期:2003-11-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/oxfordjournals.eurheartj.a015439

    authors: Redwood SR,Odemuyiwa O,Hnatkova K,Staunton A,Poloniecki I,Camm AJ,Malik M

    更新日期:1997-08-01 00:00:00

  • Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Results and safety of a simplified method.

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1053/euhj.1998.0979

    authors: De Ponti R,Zardini M,Storti C,Longobardi M,Salerno-Uriarte JA

    更新日期:1998-06-01 00:00:00

  • A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (aged > or =75 years).

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/eurheartj/ehm403

    authors: Palmerini T,Barlocco F,Santarelli A,Bacchi-Reggiani L,Savini C,Baldini E,Alessi L,Ruffini M,Di Credico G,Piovaccari G,Di Bartolomeo R,Marzocchi A,Branzi A,De Servi S

    更新日期:2007-11-01 00:00:00

  • The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome.

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1053/euhj.1998.1332

    authors: Matsuo K,Kurita T,Inagaki M,Kakishita M,Aihara N,Shimizu W,Taguchi A,Suyama K,Kamakura S,Shimomura K

    更新日期:1999-03-01 00:00:00

  • Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners.

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/eurheartj/ehn163

    authors: Möhlenkamp S,Lehmann N,Breuckmann F,Bröcker-Preuss M,Nassenstein K,Halle M,Budde T,Mann K,Barkhausen J,Heusch G,Jöckel KH,Erbel R,Marathon Study Investigators.,Heinz Nixdorf Recall Study Investigators.

    更新日期:2008-08-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1053/euhj.1999.1864

    authors: Menotti A,Puddu PE,Lanti M

    更新日期:2000-03-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/eurheartj/ehq072

    authors: Chao SP,Law WY,Kuo CJ,Hung HF,Cheng JJ,Lo HM,Shyu KG

    更新日期:2010-08-01 00:00:00

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    journal_title:European heart journal

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1093/eurheartj/14.suppl_b.30

    authors: Guermonprez JL,Blin P,Peterlongo F

    更新日期:1993-07-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/eurheartj/14.10.1344

    authors: Meluzín J,Novák M,Julínek J,Rihácek I,Urbánek D,Koukalová H,Toman J

    更新日期:1993-10-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章

    doi:10.1093/oxfordjournals.eurheartj.a060375

    authors: Brembilla-Perrot B

    更新日期:1994-01-01 00:00:00