Akino Yoshimura1, Yasuhisa Iriki1, Hitoshi Ichiki1, Naoya Oketani2, Hideki Okui1, Ryuichi Maenosono3, Fuminori Namino3, Masaaki Miyata1, Mitsuru Ohishi1. 1. Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan. 2. Department of Cardiovascular Medicine and Hypertension, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan. Electronic address: oketani@m.kufm.kagoshima-u.ac.jp. 3. Clinical Laboratory Unit, Medical and Dental Hospital, Kagoshima University, Kagoshima, Japan.
Abstract
BACKGROUND: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin. METHODS AND RESULTS: This study was a prospective, randomized registry. Patients taking NOACs upon visiting our hospital were randomly assigned into 2 groups; rivaroxaban and apixaban. Warfarin was continued in patients taking warfarin. Asymptomatic cerebral microthromboembolism was evaluated by magnetic resonance imaging on the day after the ablation procedure. In 176 consecutive patients (101 paroxysmal, and 75 persistent AF), rivaroxaban was used in 55, apixaban in 51, and warfarin in 70. There were no symptomatic cerebral infarctions in this study. Asymptomatic cerebral microthromboembolism was detected in 32 (18.4%) patients; nine (16.4%) with rivaroxaban, 10 (20%, p=0.80; vs. rivaroxaban) with apixaban, and 13 (18.8%, p=0.81; vs. rivaroxaban) with warfarin. Hemopericardium occurred in 5 (2.8%) patients; 2 with rivaroxaban, 1 with apixaban (p=1.0; vs. rivaroxaban), and 2 with warfarin (p=1.0; vs. rivaroxaban). In multivariate analysis, concomitant coronary angiography (p<0.05, odds ratio 5.73) was a predictor of cerebral thromboembolism. CONCLUSIONS: The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin.
RCT Entities:
BACKGROUND: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin. METHODS AND RESULTS: This study was a prospective, randomized registry. Patients taking NOACs upon visiting our hospital were randomly assigned into 2 groups; rivaroxaban and apixaban. Warfarin was continued in patients taking warfarin. Asymptomatic cerebral microthromboembolism was evaluated by magnetic resonance imaging on the day after the ablation procedure. In 176 consecutive patients (101 paroxysmal, and 75 persistent AF), rivaroxaban was used in 55, apixaban in 51, and warfarin in 70. There were no symptomatic cerebral infarctions in this study. Asymptomatic cerebral microthromboembolism was detected in 32 (18.4%) patients; nine (16.4%) with rivaroxaban, 10 (20%, p=0.80; vs. rivaroxaban) with apixaban, and 13 (18.8%, p=0.81; vs. rivaroxaban) with warfarin. Hemopericardium occurred in 5 (2.8%) patients; 2 with rivaroxaban, 1 with apixaban (p=1.0; vs. rivaroxaban), and 2 with warfarin (p=1.0; vs. rivaroxaban). In multivariate analysis, concomitant coronary angiography (p<0.05, odds ratio 5.73) was a predictor of cerebral thromboembolism. CONCLUSIONS: The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin.
Authors: Anene Ukaigwe; Pragya Shrestha; Paras Karmacharya; Sarah K Hussain; Soraya Samii; Mario D Gonzalez; Deborah Wolbrette; Gerald V Naccarrelli Journal: J Interv Card Electrophysiol Date: 2016-10-22 Impact factor: 1.900
Authors: Ghada A Bawazeer; Hadeel A Alkofide; Aya A Alsharafi; Nada O Babakr; Arwa M Altorkistani; Tarek S Kashour; Michael Miligkos; Khalid M AlFaleh; Lubna A Al-Ansary Journal: Cochrane Database Syst Rev Date: 2021-10-21
Authors: Stijn P G van Vugt; Sjoerd W Westra; Rick H J A Volleberg; Gerjon Hannink; Rena Nakamura; Carlo de Asmundis; Gian-Battista Chierchia; Eliano P Navarese; Marc A Brouwer Journal: Europace Date: 2021-12-07 Impact factor: 5.214