Vol 25, No 2 (2018)
Original articles — Clinical cardiology
Published online: 2017-09-13

open access

Page views 3631
Article views/downloads 1350
Get Citation

Connect on Social Media

Connect on Social Media

Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A retrospective safety analysis

Katharina Klee1, Daniel Widulle1, Martin Duckheim1, Michael Gramlich1, Christian Frische2, Meinrad Gawaz1, Peter Seizer1, Christian Eick1, Juergen Schreieck1
Pubmed: 28980285
Cardiol J 2018;25(2):213-220.


 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.  

Article available in PDF format

View PDF Download PDF file


  1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014; 64(21): e1–76.
  2. Lafuente-Lafuente C, Longas-Tejero M, Bergmann JF, et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2012.
  3. Bonanno C, Paccanaro M, La Vecchia L, et al. Efficacy and safety of catheter ablation versus antiarrhythmic drugs for atrial fibrillation: a meta-analysis of randomized trials. J Cardiovasc Med (Hagerstown). 2010; 11(6): 408–418.
  4. Vazquez SR, Johnson SA, Rondina MT. Peri-procedural anticoagulation in patients undergoing ablation for atrial fibrillation. Thromb Res. 2010; 126(2): e69–e77.
  5. Cappato R, Calkins H, Chen SA, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010; 3(1): 32–38.
  6. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138(5): 1093–1100.
  7. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011; 123(23): 2736–2747.
  8. Seizer P, Gramlich M, Frische C, et al. Postinterventional use of dabigatran in patients undergoing ablation therapy using an accelerated loading dose scheme - a single center experience. Thromb Res. 2015; 136(2): 486–487.
  9. Arshad A, Johnson CK, Mittal S, et al. Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study. Pacing Clin Electrophysiol. 2014; 37(6): 665–673.
  10. Duytschaever M, Berte B, Acena M, et al. Catheter ablation of atrial fibrillation in patients at low thrombo-embolic risk: efficacy and safety of a simplified periprocedural anticoagulation strategy. J Cardiovasc Electrophysiol. 2013; 24(8): 855–860.
  11. Nairooz R, Ayoub K, Sardar P, et al. Uninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis. Can J Cardiol. 2016; 32(6): 814–823.
  12. Wu S, Yang Ym, Zhu J, et al. Meta-Analysis of efficacy and safety of new oral anticoagulants compared with uninterrupted vitamin k antagonists in patients undergoing catheter ablation for atrial fibrillation. Am J Cardiol. 2016; 117(6): 926–934.
  13. Vamos M, Cappato R, Marchlinski FE, et al. Efficacy and safety of rivaroxaban compared with vitamin K antagonists for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Europace. 2016; 18(12): 1787–1794.
  14. Rillig A, Lin T, Plesman J, et al. Apixaban, rivaroxaban, and dabigatran in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2016; 27(2): 147–153.
  15. Kuwahara T, Abe M, Yamaki M, et al. Apixaban versus warfarin for the prevention of periprocedural cerebral thromboembolism in atrial fibrillation ablation: multicenter prospective randomized study. J Cardiovasc Electrophysiol. 2016; 27(5): 549–554.
  16. Santarpia G, De Rosa S, Polimeni A, et al. Efficacy and safety of non-vitamin k antagonist oral anticoagulants versus vitamin k antagonist oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation: a meta-analysis. PLoS One. 2015; 10(5): e0126512.
  17. Winkle RA, Mead RH, Engel G, et al. Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban. Europace. 2014; 16(10): 1443–1449.
  18. Sambola A, Mutuberría M, García Del Blanco B, et al. Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention. PLoS One. 2016; 11(1): e0147245.
  19. Sambola A, Mutuberría M, García Del Blanco B, et al. Effects of triple therapy in patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention regarding thromboembolic risk stratification. Circ J. 2016; 80(2): 354–362.
  20. Bavishi C, Koulova A, Bangalore S, et al. Evaluation of the efficacy and safety of dual antiplatelet therapy with or without warfarin in patients with a clinical indication for DAPT and chronic anticoagulation: A meta-analysis of observational studies. Catheter Cardiovasc Interv. 2016; 88(1): E12–E22.
  21. Thompson PL, Morton AC. Antithrombotic therapy in patients with combined coronary heart disease and atrial fibrillation. Panminerva Med. 2016; 58(1): 23–33.
  22. Camm AJ, Lip GY, De Ca, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. Europace. 2012; 14(10): 1385–413.
  23. Kirchhof P, Benussi S, Kotecha D, et al. Wytyczne ESC dotyczące leczenia migotania przedsionków w 2016 roku, opracowane we współpracy z EACTS. Kardiol Pol. 2016; 74(12): 1359–469.
  24. Bo M, Li Puma F, Badinella Martini M, et al. Effects of oral anticoagulant therapy in older medical in-patients with atrial fibrillation: a prospective cohort observational study. Aging Clin Exp Res. 2017; 29(3): 491–497.