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

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.

• Authors: 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
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 63 Issue 10 Pg. 982-8 (Mar 18 2014) ISSN: 1558-3597 [Electronic] United States
• PMID: 24412445 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Factor Xa Inhibitors
• Morpholines
• Thiophenes
• Rivaroxaban

Topics

• Administration, Oral
• Aged
• Anticoagulants (administration & dosage)
• Atrial Fibrillation (diagnosis, drug therapy, surgery)
• Catheter Ablation (methods)
• Dose-Response Relationship, Drug
• Factor Xa Inhibitors
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Morpholines (administration & dosage)
• Perioperative Period
• Postoperative Complications (prevention & control)
• Prospective Studies
• Registries
• Rivaroxaban
• Thiophenes (administration & dosage)
• Thromboembolism (prevention & control)
• Treatment Outcome