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Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A retrospective safety analysis
Affiliations- Kardiologie, Eberhard-Karls- Universität, Ottfried-Müller-Straße 10, 72076 Tübingen, Germany
- Pädiatrische Kardiologie, Eberhard- Karls-Universität, Hoppe- Seyler- Straße 1, 72076 Tübingen, Germany
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Abstract
Background: Catheter ablation (CA) of atrial fibrillation (AF) requires an intensified peri-interventional anticoagulation scheme to avoid thromboembolic complications. In patients with cardiac or extracardiac artery disease, an additional antiplatelet treatment (AAT) is at least temporally necessary especially after a percutaneous intervention with stent implantation. This raises the question whether these patients have a higher peri-interventional bleeding risk during CA of AF.
Methods: The data of 1235 patients with CA of AF were retrospectively analyzed in terms of bleeding events, ablation type, antithrombotic medication and comorbidities such as coronary artery disease and components of the HAS- BLED score. Peri-interventional bleeding events were classified in accordance with the BARC classification. Differentiations were made between slight femoral bleeding (based on type 1), severe femoral bleeding and pericardial effusion without pericardiocentesis (based on type 2) with the need of further hospitalization, the need of transfusion (based on type 3a) and pericardial tamponades requiring pericardiocentesis (based on type 3b).
Results: 1131/1235 (91.6%) patients were exclusively under anticoagulation and 187 (15.3%) patients were also on AAT. There were no statistically significant differences in type 1 and 3b bleeding complications or the occurrence of femoral pseudoaneurysms between both groups. However, type 2/3a bleeding complications, mostly femoral bleedings, were significantly more frequent in the patient group with AAT (3.2% vs. 7.5%, p = 0.006).
Conclusions: An additional antiplatelet therapy increases the risk of severe femoral bleeding events during CA of AF. It appears reasonable to perform the elective procedure of AF ablation after the discontinuation of AAT.
Abstract
Background: Catheter ablation (CA) of atrial fibrillation (AF) requires an intensified peri-interventional anticoagulation scheme to avoid thromboembolic complications. In patients with cardiac or extracardiac artery disease, an additional antiplatelet treatment (AAT) is at least temporally necessary especially after a percutaneous intervention with stent implantation. This raises the question whether these patients have a higher peri-interventional bleeding risk during CA of AF.
Methods: The data of 1235 patients with CA of AF were retrospectively analyzed in terms of bleeding events, ablation type, antithrombotic medication and comorbidities such as coronary artery disease and components of the HAS- BLED score. Peri-interventional bleeding events were classified in accordance with the BARC classification. Differentiations were made between slight femoral bleeding (based on type 1), severe femoral bleeding and pericardial effusion without pericardiocentesis (based on type 2) with the need of further hospitalization, the need of transfusion (based on type 3a) and pericardial tamponades requiring pericardiocentesis (based on type 3b).
Results: 1131/1235 (91.6%) patients were exclusively under anticoagulation and 187 (15.3%) patients were also on AAT. There were no statistically significant differences in type 1 and 3b bleeding complications or the occurrence of femoral pseudoaneurysms between both groups. However, type 2/3a bleeding complications, mostly femoral bleedings, were significantly more frequent in the patient group with AAT (3.2% vs. 7.5%, p = 0.006).
Conclusions: An additional antiplatelet therapy increases the risk of severe femoral bleeding events during CA of AF. It appears reasonable to perform the elective procedure of AF ablation after the discontinuation of AAT.
Keywords
atrial fibrillation ablation, antiplatelet medication, anticoagulation, femoral bleedings, percardial tamponades, pseudoaneurysms
About this articleTitle
Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A retrospective safety analysis
Journal
Issue
Pages
213-220
Published online
2017-09-13
Page views
3505
Article views/downloads
1259
DOI
10.5603/CJ.a2017.0107
Pubmed
Bibliographic record
Cardiol J 2018;25(2):213-220.
Keywords
atrial fibrillation ablation
antiplatelet medication
anticoagulation
femoral bleedings
percardial tamponades
pseudoaneurysms
Authors
Katharina Klee
Daniel Widulle
Martin Duckheim
Michael Gramlich
Christian Frische
Meinrad Gawaz
Peter Seizer
Christian Eick
Juergen Schreieck
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