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Periprocedural anticoagulants safe for patients undergoing cardioversion or ablation for AF
Warfarin, dabigatran and rivaroxaban are safe periprocedural anticoagulation options for patients undergoing cardioversion or ablation for atrial fibrillation, according to researchers in Canada.
“We demonstrated that any of the approaches described herein are reasonable for use around the time of cardioversion and ablation,” Simon Kochhäuser, MD, and colleagues wrote in their study. “All 3 agents should continue to be used in clinical practice.”
The researchers studied consecutive patients undergoing cardioversion or ablation for AF at a single Canadian center between October 2010 and October 2013. They assessed the safety of warfarin, dabigatran (Pradaxa, Boehringer Ingelheim) and rivaroxaban (Xarelto, Janssen Pharmaceuticals), by comparing rates for stroke, transient ischemic attacks and both clinically major and minor bleeding events.
Patients undergoing cardioversion had a minimum of 3 weeks of therapeutic anticoagulation prior to their procedure and a minimum of 4 weeks after. Ablation patients required a minimum of 4 weeks of anticoagulation before and 3 weeks after their procedures.
In all, 901 patients underwent cardioversion. None of these patients had a stroke; there were two transient ischemic attacks (TIAs) in the dabigatran group. Bleeding rates were low for all three anticoagulation regimens.
None of the 680 patients who underwent ablation suffered a stroke during follow-up. Two patients in the warfarin and one patient in the dabigatran group had TIAs. Once again, bleeding rates were low for all three regimens.
“Overall, we found a low incidence of thromboembolic or bleeding events around the time of the procedure for patients with AF who underwent cardioversion or ablation,” the researchers wrote. “Rates of stroke, TIA and bleeding complications were not significantly different in the three investigated groups. Warfarin, [dabigatran] and [rivaroxaban] are safe anticoagulation options around the time of the procedure for patients undergoing cardioversion or ablation for AF.”
Disclosures: Kochhäuser reports receiving research grant support from the German Cardiac Society. Please see the full study for a list of all other authors’ relevant financial disclosures.