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Warfarin given at therapeutic INR during pulmonary vein isolation yielded no additional bleeding complications
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The continuous administration of warfarin at a therapeutic international normalized ratio without heparin or enoxaparin during pulmonary vein isolation with radiofrequency ablation was safe and efficacious, study results suggested.
Researchers included 3,052 consecutive patients with atrial fibrillation who had undergone pulmonary vein isolation with radiofrequency ablation. All patients had a therapeutic INR ≥1.8 at the time of ablation. No heparin or enoxaparin (Lovenox, Sanofi-Aventis) was administered before the ablation procedures. Patients were treated with uninterrupted warfarin (Coumadin, Bristol-Myers Squibb) and were assigned 325 mg of aspirin upon hospital discharge.
A slightly higher number of patients presented to the electrophysiology lab with sinus rhythm vs. AF (1,642 vs. 1,084), with 326 patients in atrial flutter. Ischemic stroke occurred in three (0.098%) patients, with cerebrovascular hemorrhage occurring in one patient who had a minor left cerebellar hemorrhage three days after the ablation procedure. The researchers also reported bleeding complications in 34 (1.11%) patients, including 10 (0.33%) classified as major bleeding complications. Pericardial effusion occurred in nine (0.29%) patients, and five (0.16%) patients had effusions in which pericardiocentesis and reversal of anticoagulation were necessary. Three patients needed blood transfusions and 20 (0.66%) patients had hematomas requiring no intervention. Patients with hemorrhagic complications had INR values similar to those without bleeding complications (2.64 vs. 2.53; P=.78).
“Based on data from a patient population of more than 3,000 patients, continuation of [warfarin] at a therapeutic INR level at the time of radiofrequency ablation without use of heparin or enoxaparin for bridging before or after ablation is a safe and efficacious periprocedural anticoagulation strategy,” the researchers wrote. “It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.”
Hussein AA. Heart Rhythm. 2009;6:1425-1429.