Feasibility and Safety of Uninterrupted Rivaroxaban for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation
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Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation.Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown.Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period.Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 ± 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 ± 1.0 vs. 1.47 ± 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days.Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy.
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There is no safety signal from observational cohorts treated with uninterrupted NOAC therapy undergoing catheter ablation in experienced centres.
“There is no safety signal from observational cohorts treated with uninterrupted NOAC therapy undergoing catheter ablation in experienced centres.761,763,766,767”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [763]
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References 38 · Cited by 177
- Authors
- Lakkireddy, D., Reddy, Y. M., Di Biase, L., Vallakati, A., Mansour, M. C., Santangeli, P., Gangireddy, S., Swarup, V., Chalhoub, F., Atkins, D., Bommana, S., Verma, A., Sanchez, J. E., Burkhardt, J. D., Barrett, C. D., Baheiry, S., Ruskin, J., Reddy, V., & Natale, A.
- Affiliations
- The University of Kansas Health System (US)
- Massachusetts General Hospital (US)
- Texas Cardiac Arrhythmia (US)
- St. Luke's-Roosevelt Hospital Center (US)
- California Pacific Medical Center (US)
- Corresponding author
- Lakkireddy, Dhanunjaya
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-03
- Volume
- 63
- Issue
- 10
- Pages
- 982-988
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2617377817
- Cited by
- 177
- References
- 38
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 9 · 2019: 11 · 2018: 23 · 2017: 34 · 2016: 36 · 2015: 28 · 2014: 26
- FWCI
- 28.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- Funders
- Biosense Webster
- Sanofi
- Boston Scientific Corporation
- Medtronic
- Bristol-Myers Squibb
- Pfizer
- St. Jude Medical
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- rivaroxaban, periprocedural anticoagulation, atrial fibrillation, radiofrequency catheter ablation, warfarin, bleeding complications, thromboembolic events, HAS-BLED score, direct oral anticoagulants, paroxysmal atrial fibrillation, stroke prevention, transient ischemic attack, drug safety and efficacy comparison, bleeding risk stratification
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