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Canadian Journal of Cardiology

Comparison of Outcomes After Cardioversion or Atrial Fibrillation Ablation in Patients With Differing Periprocedural Anticoagulation Regimens

Published:September 25, 2014DOI:https://doi.org/10.1016/j.cjca.2014.09.018

      Abstract

      Background

      There is a paucity of data that compare traditional vitamin K antagonist (VKA) with novel oral anticoagulant regimens in periprocedural management of cardioversion or ablation of atrial fibrillation (AF). We sought to compare outcomes of use of VKA, dabigatran (DABI), and rivaroxaban (RIVA) anticoagulation around the time of intervention.

      Methods

      We studied consecutive patients undergoing cardioversion or ablation of AF at our centre from October 2010 to October 2013. There were 3 different anticoagulation groups: warfarin (VKA), DABI, and RIVA. Safety was assessed according to number of strokes, transient ischemic attacks (TIAs), and clinically important and not important bleeding events.

      Results

      Baseline characteristics were well balanced between the groups. Average follow-up was 6 months (± 4 months). A total of 901 patients who underwent cardioversion were studied (VKA [n = 471], DABI [n = 288] and RIVA [n = 141]). In these patients there were no strokes seen during follow-up and 2 TIAs in the DABI group. Bleeding rates were low, with no significant difference between the 3 groups. A total of 680 patients who underwent ablation were studied (VKA [n = 319], DABI [n = 220] and RIVA [n = 171]). There were no strokes reported during follow-up and 3 TIAs: 2 in the VKA group and 1 in the DABI group not resulting in a significant difference between the groups. Bleeding rates were low, with no significant difference between the groups.

      Conclusions

      Overall, there was a low incidence of adverse events for all anticoagulation regimens. Warfarin, DABI, and RIVA use around the time of the procedure are safe and reasonable options for patients who undergo cardioversion or AF ablation.

      Résumé

      Introduction

      Il existe peu de données qui permettent de comparer l’administration d’antagoniste traditionnel de la vitamine K (VKA) avec celle de nouveaux anticoagulants oraux pour la prise en charge périopératoire d’une cardioversion ou d’une ablation de la fibrillation auriculaire (FA). Nous avons cherché à comparer les résultats de l'utilisation de VKA, du dabigatran (DABI), et du rivaroxaban (RIVA) au moment de l'intervention.

      Méthodes

      Nous avons étudié les patients successifs ayant subi une cardioversion ou une ablation de la FA dans notre centre d'octobre 2010 à octobre 2013. Les anticoagulants définissent trois groupes différents : la warfarine (VKA), le DABI, et le RIVA. L’innocuité a été évaluée en fonction du nombre d’accidents vasculaires cérébraux (AVC), d’ischémies cérébrales transitoires (ICT), et des épisodes hémorragiques majeurs ou mineurs.

      Résultats

      Les caractéristiques initiales étaient bien équilibrées entre les groupes. Le suivi moyen était de 6 mois (± 4 mois). Un total de 901 patients ayant subi une cardioversion ont été étudiés (VKA [n = 471], DABI [n = 288] et RIVA [n = 141]). Chez ces patients, aucun AVC n’a été répertorié au cours du suivi tandis que 2 ICT l’ont été dans le groupe DABI. Les taux de saignements étaient faibles, sans différence significative entre les 3 groupes. Un total de 680 patients qui ont subi une ablation ont été étudiés (VKA [n = 319], DABI [n = 220] et RIVA [n = 171]). Aucun AVC n’a été rapporté au cours du suivi alors que 3 ICT l’ont été : 2 dans le groupe VKA et 1 dans le groupe DABI, insuffisant pour établir une différence significative entre les groupes. Les taux de saignements étaient faibles, sans différence significative entre les groupes.

      Conclusions

      Dans l'ensemble, il y avait une faible incidence des effets indésirables pour tous les régimes d’anticoagulation. L’usage de warfarine, DABI, et RIVA au cours de la procédure sont des options sûres et raisonnables pour les patients qui subissent une cardioversion ou une ablation de la FA.
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