BACKGROUND: Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB) for the treatment of atrial fibrillation. HYPOTHESIS: We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs. METHODS: In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second-generation 28-mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low-molecular-weight heparin was performed. RESULTS: Forty-seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group. CONCLUSIONS: Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second-generation CB.
BACKGROUND: Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB) for the treatment of atrial fibrillation. HYPOTHESIS: We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs. METHODS: In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second-generation 28-mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low-molecular-weight heparin was performed. RESULTS: Forty-seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group. CONCLUSIONS:Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second-generation CB.
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Authors: David Snipelisky; Jordan C Ray; Ryan Ung; Melissa Duart; Christine Kauffman; Fred Kusumoto Journal: J Interv Card Electrophysiol Date: 2014-11-08 Impact factor: 1.900
Authors: Maria Teresa Sartori; Silvia Imbergamo; Ezio Zanon; Giuseppina Bonaccorso; Giovanni Pittoni; Paolo Feltracco; Carlo Ori; Antonio Pagnan; Giuseppe Cella Journal: Clin Appl Thromb Hemost Date: 2009-07-14 Impact factor: 2.389
Authors: Luigi Di Biase; J David Burkhardt; Pasquale Santangeli; Prasant Mohanty; Javier E Sanchez; Rodney Horton; G Joseph Gallinghouse; Sakis Themistoclakis; Antonio Rossillo; Dhanunjaya Lakkireddy; Madhu Reddy; Steven Hao; Richard Hongo; Salwa Beheiry; Jason Zagrodzky; Bai Rong; Sanghamitra Mohanty; Claude S Elayi; Giovanni Forleo; Gemma Pelargonio; Maria Lucia Narducci; Antonio Dello Russo; Michela Casella; Gaetano Fassini; Claudio Tondo; Robert A Schweikert; Andrea Natale Journal: Circulation Date: 2014-04-17 Impact factor: 29.690
Authors: Riccardo Cappato; Francis E Marchlinski; Stefan H Hohnloser; Gerald V Naccarelli; Jim Xiang; David J Wilber; Chang-Sheng Ma; Susanne Hess; Darryl S Wells; George Juang; Johan Vijgen; Burkhard J Hügl; Richard Balasubramaniam; Christian De Chillou; D Wyn Davies; L Eugene Fields; Andrea Natale Journal: Eur Heart J Date: 2015-05-14 Impact factor: 29.983
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