Author + information
- Michael Bernard,
- William Brabham,
- Peter Netzler,
- Christopher Rowley,
- Michael Gold,
- Robert Leman,
- John Sturdivant,
- J. Marcus Wharton and
- Frank Cuoco
The perioperative management of anticoagulation with Atrial Fibrillation Ablation (AFA) continues to evolve. The safety profile of perioperative dabigatran and uninterrupted warfarin during AFA has been reported; however, little is known regarding the use of rivaroxaban with AFA.
Consecutive patients undergoing AFA at MUSC from Jan to Sept 2012 anticoagulated with either dabigatran (D), rivaroxaban (R) or uninterrupted warfarin (W) were included in the analysis. Pulmonary vein isolation with (persistent) or without (paroxysmal) linear lesions was performed. Anticoagulants were discontinued within 24 hours prior to the procedure and restarted within 24 hours of the procedure. Major bleeding was defined as pericardial tamponade, vascular hematoma or other bleeding requiring transfusion. Minor bleeding included a moderate to large pericardial effusion without tamponade, minor hematoma or other bleeding not requiring transfusion. Patients were followed up to 30 days.
155 D, 75 R and 44 W patients were included in the analysis. No significant differences were observed for BMI (D 30.7, R 29.3, W 30.4), LVEF (D 0.60, R 0.62, W 0.58). W was statistically different in age (D 62.7, R 63.3, W 67.3), creatinine (D 1.0, R 1.0, W 1.3), CHA2DS2-VaSC score (D 2.00, R 2.01, W 2.68). No difference was observed between D and R patients in these groups. Paroxysmal AF made up 46%, 57% and 50% of D, R and W populations, respectively (p=ns). Major complications occurred in 2/155 (1.3%) D, 1/75 (1.3%) R and 2/44 (4.5%) W patients (p=ns). Minor bleeding complications occurred in 1/155 (0.7%) D, 1/75 (1.3%) R and 2/44 (4.5%) W patients (p=ns). No thrombotic events occurred.
Dabigatran, rivaroxaban and uninterrupted warfarin have similar bleeding and thrombotic complication rates at the time of AFA. Rivaroxaban has an acceptable safety profile for AFA.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias: AF/SVT II
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1107-52
- 2013 American College of Cardiology Foundation