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Rivaroxaban may be equally effective as warfarin for AF ablation
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Uninterrupted rivaroxaban as a periprocedural anticoagulant may be similarly safe and effective as uninterrupted warfarin in patients undergoing atrial fibrillation ablation, according to recent results.
In a multicenter, observational study, the researchers evaluated 642 patients collected from a prospective registry of patients at eight facilities who underwent radiofrequency catheter ablation between January 2012 and March 2013. The cohort included 321 consecutive patients on a once-daily rivaroxaban regimen (Xarelto, Janssen Pharmaceuticals) and 321 patients treated with uninterrupted warfarin. The groups were matched for age, gender and type of AF, and all patients had received treatment for at least 30 days prior to undergoing ablation. The mean age of the patients was 63 ± 10 years; 69% were men and 51% had paroxysmal AF.
Patients in the rivaroxaban group received a dose of the medication on the evening before ablation, underwent transesophageal ECG the following morning and resumed rivaroxaban treatment the evening of the procedure. Patients in the warfarin group underwent ablation with no interruption of warfarin.
Patients in the warfarin group had a slightly higher mean HAS-BLED score (1.7 vs. 1.47; P=.032) than rivaroxaban recipients. Bleeding complications occurred in 7.3% of patients across the entire study population, and 0.3% experienced transient ischemic attacks. The researchers found no differences between the rivaroxaban and warfarin groups in the incidence of major bleeding (1.6% of the rivaroxaban group vs. 2.2% of the warfarin group; P=.0772), minor bleeding (5% vs. 5.9%; P=.602) or embolic complications (0.3% in each group; P= 1) during the first 30 days after ablation.
“In our multicenter experience, uninterrupted rivaroxaban appears to be feasible and a safe alternative to uninterrupted warfarin in patients undergoing AF ablation,” the researchers wrote. “Future larger and randomized trials are needed to confirm our findings.”
Disclosure: Lakkireddy reports receiving speakers’ honoraria from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen and St. Jude Medical.
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