Abstract | AIMS: METHODS AND RESULTS: Patients were randomized 2:1 to once-daily edoxaban 60 mg (or dose-reduced 30 mg) or dose-adjusted VKA (target international normalized ratio: 2.0-3.0). Uninterrupted anticoagulation was mandated for 21-28 days' pre-ablation and 90 days' post-ablation. During ablation, UFH administration targeted an activated clotting time (ACT) of 300-400 s. Periprocedural bleeding was differentiated between procedure-related ( bleeding at puncture side, cardiac tamponade) and unrelated events. Of 614 randomized patients, 553 received study drug and underwent catheter ablation ( edoxaban n = 375; VKA n = 178). The median (Q1-Q3) time from last dose to ablation procedure was 14.8 (13.3-16.5) vs. 16.5 (14.8-19.5) h ( edoxaban vs. VKA group, respectively). Mean ACT (SD) ≥300 s was observed in 52% edoxaban- vs. 76% VKA-treated patients, despite a higher mean (SD) UFH dose in the edoxaban vs. VKA group [14 261 (6397) IU vs. 11 473 (4300) IU; exploratory P-value < 0.0001]. In the edoxaban group, 13 patients (3.5%) had procedure-related bleeds of whom 9 had received an UFH dose above the median (13 000 IU). In the VKA arm, 7 patients (3.9%) had procedure-related bleeds of whom 3 had received an UFH dose above the median (10 225 IU). CONCLUSION: The rate of procedure-related major/clinically relevant non-major bleeding did not differ between the treatment arms despite higher doses of UFH used with edoxaban vs. VKA to achieve a target ACT during AF ablation.
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Authors | Stefan H Hohnloser, A John Camm, Riccardo Cappato, Hans-Christoph Diener, Hein Heidbüchel, Lluís Mont, Carlos A Morillo, Hans-Joachim Lanz, Heiko Rauer, Paul-Egbert Reimitz, Rüdiger Smolnik, Josef Kautzner |
Journal | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
(Europace)
Vol. 23
Issue 1
Pg. 65-72
(01 27 2021)
ISSN: 1532-2092 [Electronic] England |
PMID | 33249467
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. |
Chemical References |
- Anticoagulants
- Pyridines
- Thiazoles
- Vitamin K
- Heparin
- edoxaban
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Topics |
- Administration, Oral
- Anticoagulants
(adverse effects)
- Atrial Fibrillation
(diagnosis, drug therapy, surgery)
- Catheter Ablation
(adverse effects)
- Heparin
(adverse effects)
- Humans
- Pyridines
- Thiazoles
- Treatment Outcome
- Vitamin K
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