Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: long-term follow-up in nationwide cohort of Denmark
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AIM: To investigate the long-term risk of thromboembolism and serious bleeding associated with oral anticoagulation (OAC) therapy beyond 3 months after radiofrequency ablation (RFA) of atrial fibrillation (AF). METHODS AND RESULTS: Linking Danish administrative registries, 4050 patients undergoing first-time RFA (2000-11) were identified. Risk of thromboembolism and serious bleeding according to OAC therapy were analysed by incidence rates (presented per 100 person-years) and Cox proportional-hazard models. The median age was 59.5 years (interquartile range, IQR: 52.8-65.2); 26.5% were females. During a median follow-up of 3.4 years (IQR: 2.0-5.6), 71 (1.8%) thromboembolism cases were identified, where incidence rates with and without OAC were 0.56 (0.40-0.78)95%CI and 0.64 (0.46-0.89)95%CI, respectively. Oral anticoagulation discontinuation remained insignificant [hazard ratio 1.42(0.86-2.35)95%CI] in multivariable analysis. Beyond 3 months after RFA 87 (2.1%) serious bleedings occurred; incidence rates with and without OAC were 0.99 (0.77-1.27)95%CI and 0.44 (0.29-0.65)95%CI, respectively. Oral anticoagulation therapy was significantly associated with serious bleeding risk [hazard ratio 2.05(1.25-3.35)95%CI]. In an age- and gender-matched cohort (1 : 4) of 15 848 non-ablated AF patients receiving rhythm-control therapy, thromboembolic rates with and without OAC were 1.34 (1.21-1.49)95%CI and 2.14 (1.98-2.30)95%CI, respectively. Adjusted incidence rate ratio was 0.53 (0.43-0.65)95%CI favouring RFA cohort. CONCLUSION: Thromboembolic risk beyond 3 months after RFA was relatively low compared with a matched non-ablated AF cohort. With cautious interpretation due to low number of events, serious bleeding risk associated with OAC seems to outweigh the benefits of thromboembolic risk reduction. Randomized studies are warranted to test our results.
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Observational studies suggest a relatively low stroke rate in the first few years after catheter ablation of atrial fibrillation.
“Although observational studies suggest a relatively low stroke rate in the first few years after catheter ablation of AF, 737,[771][772][773][774][775][776]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [771]
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Cites
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Fine, J. P., & Gray, R. J. (1999) · Journal of the American Statistical Association · doi:10.1080/01621459.1999.10474144 · Cited by 14,290 · see citing works
Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010) · Chest · doi:10.1378/chest.09-1584 · Cited by 6,879 · see citing works
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,875 · see citing works
Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Europace · doi:10.1093/europace/eus027 · Cited by 2,722 · see citing works
The Danish National Hospital Register. A valuable source of data for modern health sciences.
Andersen, T. F., Madsen, M., Jørgensen, J. O. L., Mellemkjoer, L., & Olsen, J. H. (1999) · PubMed · Cited by 2,034 · see citing works
Olesen, J. B., Lip, G. Y. H., Hansen, M. L., Hansen, P. R., Tolstrup, J. S., Lindhardsen, J., Selmer, C., Ahlehoff, O., Olsen, A.-M. S., Gislason, G. H., et al. (2011) · BMJ · doi:10.1136/bmj.d124 · Cited by 1,428 · see citing works
Self-citationPappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P., Gulletta, S., Gugliotta, F., Pappone, A., Santinelli, V., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00577-1 · Cited by 779 · see citing works
Sørensen, R., Hansen, M. L., Abildstrom, S. Z., Hvelplund, A., Andersson, C., Jørgensen, C. H., Madsen, J. K., Hansen, P. R., Køber, L., Torp-Pedersen, C. T., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61751-7 · Cited by 575 · see citing works
Self-citationThe Danish prescription registries.
Gaist, D., Sørensen, H. T., & Hallas, J. (1997) · PubMed · Cited by 570 · see citing works
Madsen, M. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(02)00591-7 · Cited by 460 · see citing works
Oral, H., Chugh, A., Özaydın, M., Good, E. D., Fortino, J., Sankaran, S., Reich, S., Igic, P., Elmouchi, D., Tschopp, D. R., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.641225 · Cited by 397 · see citing works
Validity of Stroke Diagnoses in a National Register of Patients
Krarup, L.-H., Boysen, G., Janjua, H. G. R., Prescott, E., & Truelsen, T. C. (2007) · Neuroepidemiology · doi:10.1159/000102143 · Cited by 366 · see citing works
An automated database case definition for serious bleeding related to oral anticoagulant use
Cunningham, A., Stein, C., Chung, C. P., Daugherty, J. R., Smalley, W. E., & Ray, W. A. (2011) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.2109 · Cited by 359 · see citing works
Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation
Nademanee, K., Schwab, M., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D., & Ngarmukos, T. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.10.044 · Cited by 318 · see citing works
Gislason, G., Rasmussen, J. N., Abildstrom, S. Z., Gadsbøll, N., Buch, P., Friberg, J., Rasmussen, S., Køber, L., Stender, S., Madsen, M., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehi705 · Cited by 301 · see citing works
Self-citationBiase, L. D., Burkhardt, J. D., Mohanty, P. K., Sánchez, J., Horton, R., Gallinghouse, G. J., Lakkireddy, D., Verma, A., Khaykin, Y., Hongo, R. H., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.921320 · Cited by 293 · see citing works
Themistoclakis, S., Corrado, A., Marchlinski, F. E., Jais, P., Zado, E., Rossillo, A., Di Biase, L., Schweikert, R. A., Saliba, W. I., Horton, R., et al. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.11.039 · Cited by 276 · see citing works
Accuracy of a Heart Failure Diagnosis in Administrative Registers
Kümler, T., Gislason, G., Kirk, V., Bay, M., Nielsen, O. W., Køber, L., & Torp-Pedersen, C. T. (2008) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2008.05.006 · Cited by 263 · see citing works
Self-citationMérie, C., Køber, L., Olsen, P. S., Andersson, C., Gislason, G., Jensen, J. S., & Torp-Pedersen, C. T. (2012) · JAMA · doi:10.1001/jama.2012.54506 · Cited by 230 · see citing works
Self-citationOlesen, J. B., Lip, G. Y. H., Hansen, P. R., Lindhardsen, J., Ahlehoff, O., Andersson, C., Weeke, P. E., Hansen, M. L., Gislason, G., & Torp-Pedersen, C. T. (2011) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2011.04378.x · Cited by 201 · see citing works
Self-citationComplications arising from catheter ablation of atrial fibrillation: Temporal trends and predictors
Hoyt, H., Bhonsale, A., Chilukuri, K., Alhumaid, F., Needleman, M., Edwards, D., Govil, A., Nazarian, S., Cheng, A., Henrikson, C. A., et al. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.07.025 · Cited by 181 · see citing works
Joensen, A. M., Jensen, M. K., Overvad, K., Dethlefsen, C., Schmidt, E. B., Rasmussen, L., Tjønneland, A. M., & Johnsen, S. P. (2008) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2008.03.005 · Cited by 180 · see citing works
Chao, T., Lin, Y., Tsao, H.-M., Tsai, C.-F., Lin, W., Chang, S., Lo, L., Hu, Y., Tuan, T., Suenari, K., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.045 · Cited by 163 · see citing works
Bunch, T. J., May, H. T., Bair, T. L., Weiss, J. P., Crandall, B. G., Osborn, J. S., Mallender, C. D., Anderson, J. L., Muhlestein, B., LAPPE, D. L., et al. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2013.07.002 · Cited by 147 · see citing works
SCHERR, D., Sharma, K., Dalal, D., SPRAGG, D. D., Chilukuri, K., Cheng, A., Dong, J., Henrikson, C. A., Nazarian, S., Berger, R. D., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2009.01540.x · Cited by 123 · see citing works
Saad, E., d’Ávila, A., Costa, I. P., Aryana, A., Slater, C., Costa, R. E., Inácio, L. A. O., Maldonado, P., Neto, D. G. D. M., Camiletti, A. S., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.963231 · Cited by 109 · see citing works
Warfarin Is Not Needed in Low‐Risk Patients Following Atrial Fibrillation Ablation Procedures
Bunch, T. J., Crandall, B. G., Weiss, J. P., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., LAPPE, D. L., Muhlestein, J. B., Nelson, J. S., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2009.01481.x · Cited by 74 · see citing works
Kornej, J., Hindricks, G., Kosiuk, J., Arya, A., Sommer, P., Husser, D., Rolf, S., Richter, S., Piorkowski, C., Gaspar, T., et al. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000869 · Cited by 57 · see citing works
Winkle, R. A., Mead, R. H., Engel, G., Kong, M. H., & Patrawala, R. A. (2013) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-013-9835-1 · Cited by 55 · see citing works
Use of sumatriptan in Denmark in 1994–5: an epidemiological analysisof nationwide prescription data
Gaist, D., Andersen, M. T., Aarup, A., Hallas, J., & Gram, L. F. (1997) · British Journal of Clinical Pharmacology · doi:10.1046/j.1365-2125.1997.00582.x · Cited by 53 · see citing works
Chao, T., Tsao, H.-M., Kibos, A., Lin, Y., Lin, W., Chang, S., Lo, L., Hu, Y., Tuan, T., Suenari, K., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.06.039 · Cited by 45 · see citing works
Late thromboembolic events after circumferential pulmonary vein ablation of atrial fibrillation
Tao, H., Ma, C., Dong, J., et al. (2009) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-009-9455-y · Cited by 9 · see citing works
Karasoy, D., Gislason, G., Hansen, J., Olesen, J. B., Torp-Pedersen, C. T., Johannessen, A. C., & Hansen, M. L. (2013) · EP Europace · doi:10.1093/europace/eus418 · Cited by 9 · see citing works
Self-citationMohanty, S., Biase, L. D., Bai, R., Santangeli, P., Pump, A., Horton, R., Sánchez, J., & Natale, A. (2012) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.12.62 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Kornej J, Hindricks G, Kosiuk J, Arya A, Sommer P, Husser D, Rolf S, Richter S, Piorkowski C, Gaspar T, Lip GY, Bollmann A. Renal dysfunction, stroke risk scores (CHADS2, CHA2DS2-VASc, and R2CHADS2), and the risk of thromboembolic events after catheter ablation of atrial fibrillation: the Leipzig Heart Center AF Ab- lation Registry. Circ Arrhythm Electrophysiol 2013;6:868 -874.
Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
- Authors
- Karasoy, D., Gislason, G. H., Hansen, J., Johannessen, A., Køber, L., Hvidtfeldt, M., Özcan, C., Torp-Pedersen, C., & Hansen, M. L.
- Affiliations
- Gentofte Hospital (DK)
- University of Southern Denmark (DK)
- Rigshospitalet (DK)
- Corresponding author
- Karasoy, Deniz
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-11-03
- Volume
- 36
- Issue
- 5
- Pages
- 307-315
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2075511073
- Cited by
- 132
- References
- 34
- Citations by year
- 2026: 17 · 2025: 7 · 2024: 13 · 2023: 11 · 2022: 4 · 2021: 6 · 2020: 14 · 2019: 16 · 2018: 8 · 2017: 13 · 2016: 13 · 2015: 8 · 2014: 2
- FWCI
- 8.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Hjerteforeningen
- Novo Nordisk
- Novo Nordisk Fonden (NNF12OC1015957)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- oral anticoagulation, atrial fibrillation, radiofrequency ablation, thromboembolism, major bleeding, anticoagulation discontinuation, long-term follow-up, rhythm control, stroke prevention, bleeding risk, incidence rates, hazard ratio
- MeSH terms
- Administration, Oral, Aged, Anticoagulants, Atrial Fibrillation, Combined Modality Therapy, Denmark, Female, Hemorrhage, Humans, Male, Middle Aged, Risk Factors, Thromboembolism, Catheter Ablation
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