Research ExplorerPublicationsUninterrupted anticoagulation with non-vitamin K antagonist ...

Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials

Standard

Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials. / Cardoso, Rhanderson; Willems, Stephan; Gerstenfeld, Edward P; Verma, Atul; Schilling, Richard; Hohnloser, Stefan H; Okumura, Ken; Nordaby, Matias; Brouwer, Marc A; Calkins, Hugh.

In: CLIN CARDIOL, Vol. 42, No. 1, 01.2019, p. 198-205.

Research output: SCORING: Contribution to journal › SCORING: Review article › Research

Harvard

Cardoso, R, Willems, S, Gerstenfeld, EP, Verma, A, Schilling, R, Hohnloser, SH, Okumura, K, Nordaby, M, Brouwer, MA & Calkins, H 2019, 'Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials', CLIN CARDIOL, vol. 42, no. 1, pp. 198-205. https://doi.org/10.1002/clc.23120

APA

Cardoso, R., Willems, S., Gerstenfeld, E. P., Verma, A., Schilling, R., Hohnloser, S. H., Okumura, K., Nordaby, M., Brouwer, M. A., & Calkins, H. (2019). Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials. CLIN CARDIOL, 42(1), 198-205. https://doi.org/10.1002/clc.23120

Vancouver

Cardoso R, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH et al. Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials. CLIN CARDIOL. 2019 Jan;42(1):198-205. https://doi.org/10.1002/clc.23120

Bibtex

@article{68591a01429d48bb9616e5fac5251e02,
title = "Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials",
abstract = "Catheter ablation has been established as a rhythm control strategy in selected patients with atrial fibrillation (AF) who have failed or wish to avoid anti-arrhythmic drugs. Uninterrupted oral anticoagulation with vitamin K antagonists (VKAs) peri-ablation is associated with a lower risk of thromboembolic and bleeding complications as compared to interrupted oral anticoagulation and bridging heparin. However, a substantial portion of patients with AF are treated with non-vitamin K antagonist oral anticoagulants (NOACs). Herein, we perform an in-depth review and comparison of three recent randomized trials of uninterrupted oral anticoagulation with NOACs vs VKAs in patients undergoing AF catheter ablation. Furthermore, we report pooled results of these randomized trials. The pooled incidence of major bleeding was significantly lower with NOACs as compared to VKAs (2% vs 4.9%, respectively; odds ratio [OR] 0.40; 95% confidence intervals [CI] 0.16-0.99). Similarly, cardiac tamponade was also reduced in the NOAC group (0.4% vs 1.5%; OR 0.27; 95% CI 0.07-0.97). Thromboembolic complications were not significantly different between groups. Overall, these findings support the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement's class I recommendation for uninterrupted NOAC use in patients undergoing AF catheter ablation.",
keywords = "Administration, Oral, Anticoagulants/administration & dosage, Atrial Fibrillation/complications, Catheter Ablation/methods, Humans, Randomized Controlled Trials as Topic, Thromboembolism/etiology, Vitamin K/antagonists & inhibitors",
author = "Rhanderson Cardoso and Stephan Willems and Gerstenfeld, {Edward P} and Atul Verma and Richard Schilling and Hohnloser, {Stefan H} and Ken Okumura and Matias Nordaby and Brouwer, {Marc A} and Hugh Calkins",
note = "{\textcopyright} 2018 Wiley Periodicals, Inc.",
year = "2019",
month = jan,
doi = "10.1002/clc.23120",
language = "English",
volume = "42",
pages = "198--205",
journal = "CLIN CARDIOL",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

RIS

TY - JOUR

T1 - Uninterrupted anticoagulation with non-vitamin K antagonist oral anticoagulants in atrial fibrillation catheter ablation: Lessons learned from randomized trials

AU - Cardoso, Rhanderson

AU - Willems, Stephan

AU - Gerstenfeld, Edward P

AU - Verma, Atul

AU - Schilling, Richard

AU - Hohnloser, Stefan H

AU - Okumura, Ken

AU - Nordaby, Matias

AU - Brouwer, Marc A

AU - Calkins, Hugh

N1 - © 2018 Wiley Periodicals, Inc.

PY - 2019/1

Y1 - 2019/1

N2 - Catheter ablation has been established as a rhythm control strategy in selected patients with atrial fibrillation (AF) who have failed or wish to avoid anti-arrhythmic drugs. Uninterrupted oral anticoagulation with vitamin K antagonists (VKAs) peri-ablation is associated with a lower risk of thromboembolic and bleeding complications as compared to interrupted oral anticoagulation and bridging heparin. However, a substantial portion of patients with AF are treated with non-vitamin K antagonist oral anticoagulants (NOACs). Herein, we perform an in-depth review and comparison of three recent randomized trials of uninterrupted oral anticoagulation with NOACs vs VKAs in patients undergoing AF catheter ablation. Furthermore, we report pooled results of these randomized trials. The pooled incidence of major bleeding was significantly lower with NOACs as compared to VKAs (2% vs 4.9%, respectively; odds ratio [OR] 0.40; 95% confidence intervals [CI] 0.16-0.99). Similarly, cardiac tamponade was also reduced in the NOAC group (0.4% vs 1.5%; OR 0.27; 95% CI 0.07-0.97). Thromboembolic complications were not significantly different between groups. Overall, these findings support the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement's class I recommendation for uninterrupted NOAC use in patients undergoing AF catheter ablation.

AB - Catheter ablation has been established as a rhythm control strategy in selected patients with atrial fibrillation (AF) who have failed or wish to avoid anti-arrhythmic drugs. Uninterrupted oral anticoagulation with vitamin K antagonists (VKAs) peri-ablation is associated with a lower risk of thromboembolic and bleeding complications as compared to interrupted oral anticoagulation and bridging heparin. However, a substantial portion of patients with AF are treated with non-vitamin K antagonist oral anticoagulants (NOACs). Herein, we perform an in-depth review and comparison of three recent randomized trials of uninterrupted oral anticoagulation with NOACs vs VKAs in patients undergoing AF catheter ablation. Furthermore, we report pooled results of these randomized trials. The pooled incidence of major bleeding was significantly lower with NOACs as compared to VKAs (2% vs 4.9%, respectively; odds ratio [OR] 0.40; 95% confidence intervals [CI] 0.16-0.99). Similarly, cardiac tamponade was also reduced in the NOAC group (0.4% vs 1.5%; OR 0.27; 95% CI 0.07-0.97). Thromboembolic complications were not significantly different between groups. Overall, these findings support the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement's class I recommendation for uninterrupted NOAC use in patients undergoing AF catheter ablation.

KW - Administration, Oral

KW - Anticoagulants/administration & dosage

KW - Atrial Fibrillation/complications

KW - Catheter Ablation/methods

KW - Humans

KW - Randomized Controlled Trials as Topic

KW - Thromboembolism/etiology

KW - Vitamin K/antagonists & inhibitors

U2 - 10.1002/clc.23120

DO - 10.1002/clc.23120

M3 - SCORING: Review article

C2 - 30460702

VL - 42

SP - 198

EP - 205

JO - CLIN CARDIOL

JF - CLIN CARDIOL

SN - 0160-9289

IS - 1

ER -